Provider Demographics
NPI:1144418161
Name:ADVANCED DIABETES & ENDOCRINE MEDICAL CENTER
Entity Type:Organization
Organization Name:ADVANCED DIABETES & ENDOCRINE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RITA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:RAHBANY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-256-9490
Mailing Address - Street 1:9166 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-1709
Mailing Address - Country:US
Mailing Address - Phone:407-673-4600
Mailing Address - Fax:407-673-4601
Practice Address - Street 1:9166 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-1709
Practice Address - Country:US
Practice Address - Phone:407-673-4600
Practice Address - Fax:407-673-4601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0007978013OtherAETNA
FL46901OtherBLUE CROSS
FL256771700Medicaid
FL4099709012OtherCIGNA
FLG95309OtherUPIN
FLK7687Medicare PIN