| NPI | 1639365158 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL W FORMISANO President 954-989-4110 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME 91614) |
| Enumeration Date | 2007-09-18 |
| Last Update Date | 2007-11-15 |