Organization
CUSTOM CARE MEDICAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS BURKS MD (OWNER)
(813) 515-6676
Entity
Organization
Contact information
Practice address
1931 W MARTIN LUTHER KING JR BLVD, STE E, TAMPA, FL 33607
(813) 515-6676
(813) 515-6685
Mailing address
1931 W MARTIN LUTHER KING JR BLVD, STE E, TAMPA, FL 33607
(813) 515-6676
(813) 515-6685
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
03/24/2025
Last updated
03/24/2025
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