Organization
POURKESALI ENTERPRISES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARTIN M POURKESALI D.O (OWNER)
(386) 246-6289
Entity
Organization
Contact information
Practice address
28 OFFICE PARK DR, PALM COAST, FL 32137-3808
(386) 246-6289
Mailing address
28 OFFICE PARK DR, PALM COAST, FL 32137-3808
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
OS8658
FL
Other
Enumeration date
10/04/2010
Last updated
10/04/2010
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