Provider Demographics
NPI:1386268993
Name:FLORIDA ADVANCED MEDICINE LLC
Entity type:Organization
Organization Name:FLORIDA ADVANCED MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABBAS
Authorized Official - Middle Name:
Authorized Official - Last Name:RIZVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-738-0803
Mailing Address - Street 1:13550 VILLAGE PARK DR STE 220
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-7835
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:833-398-2081
Practice Address - Street 1:13550 VILLAGE PARK DR STE 220
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-7835
Practice Address - Country:US
Practice Address - Phone:407-738-0803
Practice Address - Fax:833-398-2081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-31
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty