Provider Demographics
NPI:1013192483
Name:DIABETES AND ENDOCRINE CENTER OF
Entity Type:Organization
Organization Name:DIABETES AND ENDOCRINE CENTER OF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIKRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-248-9990
Mailing Address - Street 1:7300 SANDLAKE COMMONS BLVD
Mailing Address - Street 2:SUITE# 112
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-8050
Mailing Address - Country:US
Mailing Address - Phone:407-248-9990
Mailing Address - Fax:407-248-2985
Practice Address - Street 1:7300 SANDLAKE COMMONS BLVD
Practice Address - Street 2:SUITE# 112
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8050
Practice Address - Country:US
Practice Address - Phone:407-248-9990
Practice Address - Fax:407-248-2985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70379174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1366425654OtherNPI
G56233Medicare UPIN
FLK6525Medicare PIN