| Beena Koppuzha MD PA | |
|
1141 S Mccall Rd Englewood FL 34223-4229 | |
| (941) 475-6568 | |
| (941) 474-6706 |
| Full Name | Beena Koppuzha MD PA |
|---|---|
| Speciality | Internal Medicine |
| Location | 1141 S Mccall Rd, Englewood, Florida |
| Authorized Official Name and Position | Beena C Koppuzha (PHYSICIAN) |
| Authorized Official Contact | 9414756568 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Beena Koppuzha MD PA 1141 S Mccall Rd Englewood FL 34223-4229 Ph: (941) 475-6568 | Beena Koppuzha MD PA 1141 S Mccall Rd Englewood FL 34223-4229 Ph: (941) 475-6568 |
| NPI Number | 1194766550 |
|---|---|
| Provider Enumeration Date | 06/09/2006 |
| Last Update Date | 07/16/2010 |
| Medicare PECOS PAC ID | 7012083959 |
|---|---|
| Medicare Enrollment ID | O20080829000235 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194766550 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | ME0075143 (Florida) | Primary |
| Provider Name | Beena Cyriac Koppuzha |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1710938402 PECOS PAC ID: 1456306588 Enrollment ID: I20050323000405 |
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