Organization
CCM SPECIALISTS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AJAY K DHAWAN MD (MEDICAL DIRECTOR)
(239) 699-5830
Entity
Organization
Contact information
Practice address
1108 AMBER LAKE CT, CAPE CORAL, FL 33909
(425) 270-5432
Mailing address
1108 AMBER LAKE CT, CAPE CORAL, FL 33909
(425) 270-5432
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
ME105093
FL
Other
Enumeration date
12/26/2014
Last updated
12/26/2014
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