Provider Demographics
NPI:1104098565
Name:GEORGE R IKELER MD PA
Entity type:Organization
Organization Name:GEORGE R IKELER MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:R
Authorized Official - Last Name:IKELER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-735-4044
Mailing Address - Street 1:31450 CHURCH STREET
Mailing Address - Street 2:
Mailing Address - City:SORRENTO
Mailing Address - State:FL
Mailing Address - Zip Code:32776-9594
Mailing Address - Country:US
Mailing Address - Phone:352-735-4044
Mailing Address - Fax:352-735-2536
Practice Address - Street 1:31450 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:SORRENTO
Practice Address - State:FL
Practice Address - Zip Code:32776-9594
Practice Address - Country:US
Practice Address - Phone:352-735-4044
Practice Address - Fax:352-735-2536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME12314261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108955Medicare Oscar/Certification