Provider Demographics
NPI:1427243062
Name:PRIVATE HEALTH MD PA
Entity type:Organization
Organization Name:PRIVATE HEALTH MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-670-9868
Mailing Address - Street 1:300 N PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-3773
Mailing Address - Country:US
Mailing Address - Phone:407-628-1081
Mailing Address - Fax:407-628-1806
Practice Address - Street 1:300 N PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-3773
Practice Address - Country:US
Practice Address - Phone:407-628-1081
Practice Address - Fax:407-628-1806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59499207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty