Organization
IDICULA MEDICAL ASSOCIATES MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH IDICULA (PRESIDENT)
(352) 596-4660
Entity
Organization
Contact information
Practice address
10065 CORTEZ BLVD, BROOKSVILLE, FL 34613
(352) 596-4660
(352) 596-4674
Mailing address
10065 CORTEZ BLVD, WEEKI WACHEE, FL 34613-6389
(352) 596-4660
(352) 596-4674
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CH6323
RAILROAD MEDICARE
FL
Enumeration date
11/01/2006
Last updated
10/26/2009
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