Provider Demographics
NPI:1346045739
Name:MAULORICO MCFADDEN HOLDING CO LLC
Entity type:Organization
Organization Name:MAULORICO MCFADDEN HOLDING CO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-619-9740
Mailing Address - Street 1:3234 S FLORIDA AVE STE F
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-4564
Mailing Address - Country:US
Mailing Address - Phone:863-619-9740
Mailing Address - Fax:863-644-4178
Practice Address - Street 1:3234 S FLORIDA AVE STE F
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-4564
Practice Address - Country:US
Practice Address - Phone:863-619-9740
Practice Address - Fax:863-644-4178
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAULORICO MCFADDEN HOLDING CO LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity MedicineGroup - Single Specialty