Organization
MEDI MELBOURNE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS K WILLETT (MANAGING MEMBER)
(813) 245-5305
Entity
Organization
Contact information
Practice address
7630 N WICKHAM RD, SUITE 104, MELBOURNE, FL 32940-8257
(321) 610-7982
Mailing address
412 E MADISON ST, SUITE 1100, TAMPA, FL 33602-4601
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
10/06/2015
Last updated
10/26/2016
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