Provider Demographics
NPI:1124049317
Name:MEDICAL ASSOCIATES OF CENTRAL FLORIDA
Entity type:Organization
Organization Name:MEDICAL ASSOCIATES OF CENTRAL FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHESH
Authorized Official - Middle Name:GANDHI
Authorized Official - Last Name:ALLAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-877-2411
Mailing Address - Street 1:1110 DRUID CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33853-4307
Mailing Address - Country:US
Mailing Address - Phone:863-877-2411
Mailing Address - Fax:863-354-6617
Practice Address - Street 1:1110 DRUID CIR
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853-4307
Practice Address - Country:US
Practice Address - Phone:863-877-2411
Practice Address - Fax:863-354-6617
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL ASSOCIATES OF CENTRAL FLORIDA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-22
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64990207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL23488OtherBCBS OF FL
FL45617OtherMEDICARE GROUP IDENTIFIER
FLCH8733OtherMEDICARE RAILROAD
FL263360400Medicaid
FL=========OtherTRICARE
FL=========OtherAETNA
FL=========OtherFIRST HEALTH
FL45617OtherMEDICARE GROUP IDENTIFIER
FL=========OtherCCN/ONE SOURCE
FL=========OtherSOUTHCARE
FL23488OtherBCBS OF FL
FL=========OtherBEECHSTREET
FL=========OtherFIRST SERVICE ADMINISTRAT
FL=========OtherPHCS
FL=========OtherAVMED
FL=========OtherCIGNA
FL=========OtherUNITED HEALTHCARE
FLCH8733OtherMEDICARE RAILROAD
FL=========OtherPHCS