Provider Demographics
NPI:1356005342
Name:VMD PRIMARY PROVIDERS CENTRAL FLORIDA PLLC
Entity Type:Organization
Organization Name:VMD PRIMARY PROVIDERS CENTRAL FLORIDA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:I
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-513-4897
Mailing Address - Street 1:125 S CLARK ST STE 900
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-4043
Mailing Address - Country:US
Mailing Address - Phone:713-461-2915
Mailing Address - Fax:
Practice Address - Street 1:800 W BAY DR UNIT 1
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-3222
Practice Address - Country:US
Practice Address - Phone:407-798-8800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VMD PRIMARY PROVIDERS CENTRAL FLORIDA PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty