Organization
IMMOKALEE FAMILY DOCTOR'S CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREA KEPPEL MA (OFFICE MANAGER)
(239) 657-2779
Entity
Organization
Contact information
Practice address
555 N 15TH ST UNIT A, IMMOKALEE, FL 34142-2824
(239) 657-2779
(239) 657-3335
Mailing address
555 N 15TH ST UNIT A, IMMOKALEE, FL 34142-2824
(239) 657-2779
(239) 657-3335
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
ME42490
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113836500
—
FL
Enumeration date
06/06/2012
Last updated
04/25/2022
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