| Icmd Pa | |
|
10770 Se 173rd St Summerfield FL 34491-6851 | |
| (352) 455-2026 | |
| (352) 748-2700 |
| Full Name | Icmd Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 10770 Se 173rd St, Summerfield, Florida |
| Authorized Official Name and Position | Fariborz Delbakhsh (OWNER, PRESIDENT) |
| Authorized Official Contact | 3524552026 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Icmd Pa 10770 Se 173rd St Summerfield FL 34491-6851 Ph: (352) 455-2026 | Icmd Pa 10770 Se 173rd St Summerfield FL 34491-6851 Ph: (352) 455-2026 |
| NPI Number | 1962091520 |
|---|---|
| Provider Enumeration Date | 01/18/2021 |
| Last Update Date | 01/18/2021 |
| Medicare PECOS PAC ID | 0143638478 |
|---|---|
| Medicare Enrollment ID | O20210426001495 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962091520 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Fariborz Delbakhsh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548299712 PECOS PAC ID: 2466425723 Enrollment ID: I20040816000288 |
| Provider Name | Derrick J Martin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1104980812 PECOS PAC ID: 9133027055 Enrollment ID: I20080625000375 |
| Provider Name | Debra Lee Fonseca |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073967287 PECOS PAC ID: 0941584817 Enrollment ID: I20170222000317 |
| Provider Name | Jocelyn C Eslinger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083159107 PECOS PAC ID: 6305102039 Enrollment ID: I20180131003016 |
| Provider Name | Fariborz Delbakhsh |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1548299712 PECOS PAC ID: 2466425723 Enrollment ID: I20210426001577 |
| Provider Name | Anthony Arias Bravo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508467374 PECOS PAC ID: 7315482312 Enrollment ID: I20240829003604 |
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