Provider Demographics
NPI:1114146776
Name:NORTH FLORIDA INTERNAL MEDICINE PA
Entity Type:Organization
Organization Name:NORTH FLORIDA INTERNAL MEDICINE PA
Other - Org Name:NORTH FLORIDA INTEGRATIVE MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELI
Authorized Official - Middle Name:MAUN
Authorized Official - Last Name:AKEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-332-6680
Mailing Address - Street 1:6228 NW 43RD ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-8871
Mailing Address - Country:US
Mailing Address - Phone:352-332-6680
Mailing Address - Fax:352-332-6604
Practice Address - Street 1:6228 NW 43RD ST
Practice Address - Street 2:SUITE B
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653-8871
Practice Address - Country:US
Practice Address - Phone:352-332-6680
Practice Address - Fax:352-332-6604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73570207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006779300Medicaid
FLAB974Medicare PIN