GULF COAST INTERNAL MEDICINE PA
Medical Practice at Metropolis Ave, Fort Myers, FL

License number
Florida ME81543
Category
Medical Practice
Type
Specialist
Owner
Name: TANZEEN AHMED
Title: OWNER
Phone: (239) 986-0259
Address
Address
14131 Metropolis Ave SUITE 106, Fort Myers, FL 33912
National Provider ID: 1114125606
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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GULF COAST INTERNAL MEDICINE, PA

Fort Myers, FL

Industry:
Medical Doctor's Office
Registration:
Jul 6, 2005
Addresses:
14131 Metropolis Ave SUITE 106, Fort Myers, FL 33912 (Physical)
PO Box 60205, Fort Myers, FL 33906
State ID:
P05000095410
Business type:
Florida Profit Corporation
Office Managers:
Tanzeen Ahmed (Internal Medicine, Medical Doctor, Owner, Principal, President, Treasurer, Director, Secretary), 9099 Pasco De Valencia St, Fort Myers, FL 33908 (Physical),Tammy D. Maxie (Office Manager)
Agent:
John Wicker,12670 New Brittany Blvd STE 101, Fort Myers, FL 33907 (Physical)
EIN:
20-3225703

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