Organization
COASTAL SKILLED CARE PROVIDERS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LOTHAR MICHAEL GEBAUER MD (OFFICER)
(407) 496-9399
Entity
Organization
Contact information
Practice address
767 TIMOTHY ST, ORMOND BEACH, FL 32174-2909
(407) 496-9399
Mailing address
767 TIMOTHY ST, ORMOND BEACH, FL 32174-2909
(407) 496-9399
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME98984
FL
Other
Enumeration date
07/09/2014
Last updated
07/09/2014
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