Provider Demographics
NPI:1245596964
Name:FLORIDA ID CARE LLC
Entity Type:Organization
Organization Name:FLORIDA ID CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SIVAKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-245-8223
Mailing Address - Street 1:14192 METROPOLIS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4331
Mailing Address - Country:US
Mailing Address - Phone:239-245-8223
Mailing Address - Fax:239-244-9481
Practice Address - Street 1:3540 STUART CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-7737
Practice Address - Country:US
Practice Address - Phone:609-350-4757
Practice Address - Fax:239-244-9481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-06
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100391207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty