| Mis Provider Network Llc | |
|
170 Fitzgerald Rd Ste 1 Lakeland FL 33813-2633 | |
| (813) 687-5858 | |
| Not Available |
| Full Name | Mis Provider Network Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 170 Fitzgerald Rd Ste 1, Lakeland, Florida |
| Authorized Official Name and Position | Wendy L Bradshaw (OWNER) |
| Authorized Official Contact | 8136875858 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mis Provider Network Llc 170 Fitzgerald Rd Ste 1 Lakeland FL 33813-2633 Ph: (813) 687-5858 | Mis Provider Network Llc 170 Fitzgerald Rd Ste 1 Lakeland FL 33813-2633 Ph: (813) 687-5858 |
| NPI Number | 1700529369 |
|---|---|
| Provider Enumeration Date | 04/20/2022 |
| Last Update Date | 04/20/2022 |
| Certification Date | 04/20/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700529369 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Secondary |
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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› Verified 4 days ago
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