Organization
COVENANT MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MOBOLANLE FADARE (OWNER)
(813) 874-0850
Entity
Organization
Contact information
Practice address
2812 W DR MARTIN LUTHER KING JR BLVD, SUITE 2, TAMPA, FL 33607-6306
(813) 874-0850
(813) 874-0590
Mailing address
2812 W DR MARTIN LUTHER KING JR BLVD, SUITE 2, TAMPA, FL 33607-6306
(813) 874-0850
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
126336
FL
Other
Enumeration date
02/16/2010
Last updated
02/16/2010
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