Organization
INDIGO DERMATOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUMEET THAREJA M.D. (OWNER)
(321) 951-1010
Entity
Organization
Contact information
Practice address
675 S BABCOCK ST, MELBOURNE, FL 32901-1459
(321) 951-1010
(321) 952-4038
Mailing address
675 S BABCOCK ST, MELBOURNE, FL 32901-1459
(321) 951-1010
(321) 952-4038
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME123157
FL
Other
Enumeration date
10/26/2015
Last updated
07/04/2019
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