| Ic Professional Services Inc. | |
|
1200 Nw 78th Ave Ste 215 Doral FL 33126-1890 | |
| (786) 452-8963 | |
| (305) 675-2727 |
| Full Name | Ic Professional Services Inc. |
|---|---|
| Speciality | Internal Medicine |
| Location | 1200 Nw 78th Ave Ste 215, Doral, Florida |
| Authorized Official Name and Position | Iliana Camejo (OWNER) |
| Authorized Official Contact | 7864528963 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ic Professional Services Inc. 1200 Nw 78th Ave Ste 215 Doral FL 33126-1890 Ph: (786) 452-8963 | Ic Professional Services Inc. 1200 Nw 78th Ave Ste 215 Doral FL 33126-1890 Ph: (786) 452-8963 |
| NPI Number | 1841939758 |
|---|---|
| Provider Enumeration Date | 05/31/2022 |
| Last Update Date | 12/22/2022 |
| Medicare PECOS PAC ID | 1759760770 |
|---|---|
| Medicare Enrollment ID | O20220622002441 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841939758 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207RN0300X | Internal Medicine - Nephrology | (* (Not Available)) | Primary |
| Provider Name | Elio A. Torres-lopez |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1992919526 PECOS PAC ID: 2769646041 Enrollment ID: I20130918000572 |
| Provider Name | Iliana Camejo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093462418 PECOS PAC ID: 1658750674 Enrollment ID: I20220623000181 |
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