| Angelic Lift | |
|
4645 Clyde Morris Blvd Ste 404 Port Orange FL 32129-3005 | |
| (386) 855-8633 | |
| (855) 857-5810 |
| Full Name | Angelic Lift |
|---|---|
| Speciality | Internal Medicine |
| Location | 4645 Clyde Morris Blvd Ste 404, Port Orange, Florida |
| Authorized Official Name and Position | Tinuade Olusegun (OWNER) |
| Authorized Official Contact | 3868558633 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Angelic Lift 4645 Clyde Morris Blvd Ste 404 Port Orange FL 32129-3005 Ph: (386) 855-8633 | Angelic Lift 4645 Clyde Morris Blvd Ste 404 Port Orange FL 32129-3005 Ph: (386) 855-8633 |
| NPI Number | 1295221711 |
|---|---|
| Provider Enumeration Date | 07/09/2018 |
| Last Update Date | 12/13/2022 |
| Certification Date | 12/13/2022 |
| Medicare PECOS PAC ID | 5698012946 |
|---|---|
| Medicare Enrollment ID | O20190124003498 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295221711 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
| Provider Name | Tinuade Olusegun |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1760649917 PECOS PAC ID: 6406993971 Enrollment ID: I20190124003568 |
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