Provider Demographics
NPI:1275578395
Name:MID-FLORIDA UROLOGICAL ASSOCIATES PA
Entity Type:Organization
Organization Name:MID-FLORIDA UROLOGICAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PARTNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DONAHUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-896-1181
Mailing Address - Street 1:1616 WOODWARD ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-4142
Mailing Address - Country:US
Mailing Address - Phone:407-896-1181
Mailing Address - Fax:407-898-1623
Practice Address - Street 1:1616 WOODWARD ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-4142
Practice Address - Country:US
Practice Address - Phone:407-896-1181
Practice Address - Fax:407-898-1623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL202243500Medicaid
FL00682Medicare PIN