| George Idiculla Md,pa | |
|
1029 Florida Ave S Rockledge FL 32955-2160 | |
| (321) 638-0888 | |
| Not Available |
| Full Name | George Idiculla Md,pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 1029 Florida Ave S, Rockledge, Florida |
| Authorized Official Name and Position | George A Idiculla (PRESIDENT) |
| Authorized Official Contact | 3216380888 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| George Idiculla Md,pa 1029 Florida Ave S Rockledge FL 32955-2160 Ph: (321) 638-0888 | George Idiculla Md,pa 1029 Florida Ave S Rockledge FL 32955-2160 Ph: (321) 638-0888 |
| NPI Number | 1013289859 |
|---|---|
| Provider Enumeration Date | 02/08/2012 |
| Last Update Date | 07/30/2013 |
| Medicare PECOS PAC ID | 2668629742 |
|---|---|
| Medicare Enrollment ID | O20120824000107 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013289859 | NPI | - | NPPES |
| 376630600 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | ME0066869 (Florida) | Primary |
| Provider Name | George A Idiculla |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891806642 PECOS PAC ID: 0345272043 Enrollment ID: I20050901000868 |
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