Organization
BLUEGRASS ID ASSOCIATED LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GAZALA KHAN (MANAGER)
(714) 944-8105
Entity
Organization
Contact information
Practice address
BLUEGRASS ID ASSOCIATED LLC, 1848 FOX CT, WELLINGTON, FL 33414
(714) 944-8105
Mailing address
BLUEGRASS ID ASSOCIATES LLC, 1848 FOX CT, WELLINGTON, FL 33414
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
—
—
Other
Enumeration date
07/18/2024
Last updated
07/18/2024
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