TUI FAMILY MEDICINE PL
Ambulatory Health at Clyde Morris Blvd, Daytona Beach, FL

License number
Florida ME 95967
Category
Ambulatory Health
Type
Clinic/Center
Owner
Name: ANUNPORN SRISAWAT MD
Title: MANAGING MEMBER
Phone: (386) 304-2990
Address
Address
4554 S Clyde Morris Blvd SUITE 2, Daytona Beach, FL 32129
National Provider ID: 1386940013
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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TUI FAMILY MEDICINE PL

Daytona Beach, FL

Industry:
Health/Allied Services
Doing business as:
Tui Family Medicine
Registration:
Oct 6, 2010
Phone:
(386) 304-2990 (Phone)
Addresses:
4554 Clyde Morris Blvd SUITE 2, Port Orange, FL 32129 (Physical)
Port Orange, FL 32129 (Mailing)
3817 Calliope Ave, Daytona Beach, FL 32129
PO Box 290035, Daytona Beach, FL 32129
State ID:
L10000104409
Business type:
Florida Limited Liability Company
S:
Anunporn Srisawat (Managing Member), 3817 Calliope Ave, Port Orange, FL 32129 (Physical),Suid W Srisawat, 660 W Bonita Ave, Claremont, CA 91711 (Physical)
Agent:
Srisawat, Anunporn,3817 Calliope Ave, Port Orange, FL 32129 (Physical)
EIN:
273657146
Categories:
Family & General Practice Physicians & Surgeons, Physicians & Surgeons

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