Mishra, Poonam
Mishra, Poonam is an individual health care provider with primary practice located at 401 N Wickham Rd Suite H, Melbourne FL 32935-8659. She recently has only one registered license in Allopathic & Osteopathic Physicians / Adult Medicine, which is considered as her primary health care specialty. Mishra, Poonam can be contacted via phone (321) 757-5105.Contact Information
Primary practice address
401 N Wickham Rd Suite H
Melbourne FL 32935-8659
Phone: (321) 757-5105
Fax: (321) 757-5104
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Adult Medicine | 207QA0505X | 593360315 | Florida |
Profile Details
| NPI number | 1306836952 |
|---|---|
| LBN Legal business name | Mishra, Poonam |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 25th, 2005 |
| Last updated | Feb 6th, 2015 - about 11 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1306836952 | NPPES |
| Florida | Other | 40462 | BCBS MAB GROUP |
| Florida | Other | 57174 | BCBS MAB GROUP |
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