Provider Demographics
NPI:1316960297
Name:ASSOCIATES IN DERMATOLOGY INC
Entity type:Organization
Organization Name:ASSOCIATES IN DERMATOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-846-7546
Mailing Address - Street 1:PO BOX 690609
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32869-0609
Mailing Address - Country:US
Mailing Address - Phone:407-846-7546
Mailing Address - Fax:321-206-5419
Practice Address - Street 1:725 E OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-4591
Practice Address - Country:US
Practice Address - Phone:407-846-7546
Practice Address - Fax:321-206-5419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2019-09-05
Deactivation Date:2019-08-27
Deactivation Code:
Reactivation Date:2019-09-05
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL72585Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER