Individual
DR. AGNES IDICULA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10065 CORTEZ BLVD, WEEKI WACHEE, FL 34613-6389
(352) 596-4660
(352) 596-4674
Mailing address
10065 CORTEZ BLVD, WEEKI WACHEE, FL 34613-6389
(352) 596-4660
(352) 596-4674
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME59607
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110213555
RAILROAD MEDICARE
FL
01
—
45554
MEDICARE&BCBS GROUP #
FL
Enumeration date
06/01/2005
Last updated
04/06/2011
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