Organization
IDEAL BODY INSTITUTE HUDSON ASC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER IBIKUNLE (MD)
(678) 466-6760
Entity
Organization
Contact information
Practice address
14012 US HIGHWAY 19, HUDSON, FL 34667-1165
(678) 466-6760
(678) 802-7094
Mailing address
367 ATHENS HWY STE 100, LOGANVILLE, GA 30052-2207
(678) 466-6760
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
04/19/2022
Last updated
04/19/2022
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