Provider Demographics
NPI:1265470751
Name:A ADVANCE MEDICAL GROUP
Entity Type:Organization
Organization Name:A ADVANCE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:R
Authorized Official - Last Name:MARICHAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-575-3839
Mailing Address - Street 1:724 CHARLES ST
Mailing Address - Street 2:B
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-7509
Mailing Address - Country:US
Mailing Address - Phone:407-575-3889
Mailing Address - Fax:
Practice Address - Street 1:724 CHARLES ST
Practice Address - Street 2:B
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-7509
Practice Address - Country:US
Practice Address - Phone:407-575-3889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9322Medicare ID - Type UnspecifiedMEDICARE