Provider Demographics
NPI:1154550747
Name:INFECTIOUS DISEASES ASSOCIATES OF NORTH CENTRAL FLORIDA LLC
Entity type:Organization
Organization Name:INFECTIOUS DISEASES ASSOCIATES OF NORTH CENTRAL FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MBR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANBALAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-867-8805
Mailing Address - Street 1:3306 SW 26TH AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-7856
Mailing Address - Country:US
Mailing Address - Phone:352-867-8805
Mailing Address - Fax:352-867-8844
Practice Address - Street 1:3306 SW 26TH AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-7856
Practice Address - Country:US
Practice Address - Phone:352-867-8805
Practice Address - Fax:352-867-8844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-06
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95964207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DP3525OtherRAILROAD MEDICARE
FLCB651AMedicare PIN