Provider Demographics
NPI:1528953247
Name:ADIA MED OF WINTER PARK LLC
Entity type:Organization
Organization Name:ADIA MED OF WINTER PARK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:POWALISZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-231-2843
Mailing Address - Street 1:4421 GABRIELLA LN
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-6325
Mailing Address - Country:US
Mailing Address - Phone:321-231-2843
Mailing Address - Fax:
Practice Address - Street 1:1561 W FAIRBANKS AVE STE 205
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4678
Practice Address - Country:US
Practice Address - Phone:321-231-2843
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty