Provider Demographics
NPI:1245414911
Name:F M ABANILLA MD PA
Entity Type:Organization
Organization Name:F M ABANILLA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:MELOCOTON
Authorized Official - Last Name:ABANILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-314-0555
Mailing Address - Street 1:3030 US 27 S
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-9761
Mailing Address - Country:US
Mailing Address - Phone:863-314-0555
Mailing Address - Fax:863-314-0806
Practice Address - Street 1:3030 US 27 S
Practice Address - Street 2:
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825-9761
Practice Address - Country:US
Practice Address - Phone:863-314-0555
Practice Address - Fax:863-314-0806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066898261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF93735Medicare UPIN
FLAH242Medicare PIN