Main Street Medical Clinic

NPI #1346570389 in Thonotosassa, Florida

Provider Information

NPI Number: 1346570389
Entity Type: Organization
Organization Name: Main Street Medical Clinic
Primary Specialty: Specialist
Enumeration Date: Jan 13, 2010
Last Updated: Jan 13, 2010

Practice Location

Address: 10802 E. MAIN ST
Address 2: STE B
City: Thonotosassa
State: Florida
ZIP Code: 33592-2840
Phone: (813) 413-8258

Authorized Official

Name: MRS. OMOSALEWA OGUNDIPE
Title: DIRECTOR
Phone: (813) 413-8258

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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