Provider Demographics
NPI:1073181913
Name:ORLANDO FAMILY PHYSICIANS, LLC
Entity Type:Organization
Organization Name:ORLANDO FAMILY PHYSICIANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PENELOPE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOKKINIDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-270-7825
Mailing Address - Street 1:6900 TAVISTOCK LAKES BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7592
Mailing Address - Country:US
Mailing Address - Phone:321-332-6947
Mailing Address - Fax:
Practice Address - Street 1:900 S GOLDENROD RD STE B
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8113
Practice Address - Country:US
Practice Address - Phone:407-362-0148
Practice Address - Fax:407-271-8436
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORLANDO FAMILY PHYSICIANS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-16
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101312515Medicaid