Provider Demographics
NPI:1235432543
Name:MEDICAL ASSOCIATES OF CENTRAL FLORIDA
Entity Type:Organization
Organization Name:MEDICAL ASSOCIATES OF CENTRAL FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHESH
Authorized Official - Middle Name:GANDI
Authorized Official - Last Name:ALLAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-439-9775
Mailing Address - Street 1:31810 HWY 27
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-7617
Mailing Address - Country:US
Mailing Address - Phone:863-439-9775
Mailing Address - Fax:863-439-0066
Practice Address - Street 1:31810 HWY 27
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-7617
Practice Address - Country:US
Practice Address - Phone:863-439-9775
Practice Address - Fax:863-439-0066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2832442363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP29047Medicare UPIN