Provider Demographics
NPI:1720061880
Name:FUNAI, EDMUND F (MD)
Entity type:Individual
Prefix:
First Name:EDMUND
Middle Name:F
Last Name:FUNAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 917770
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-7770
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9332 STATE ROAD 54 STE 407
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-1810
Practice Address - Country:US
Practice Address - Phone:727-375-7295
Practice Address - Fax:727-375-7194
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.098393207VM0101X
CT040482207VM0101X
FLME126203207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016569000Medicaid
FLRI2OXOtherBLUE CROSS BLUE SHIELD
FLIM719ZMedicare PIN