Provider Demographics
NPI:1376233346
Name:ORLANDO PRIMARY MEDICINE, LLC
Entity Type:Organization
Organization Name:ORLANDO PRIMARY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VINEEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SOMPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-482-7788
Mailing Address - Street 1:11616 LAKE UNDERHILL RD STE 215
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-4465
Mailing Address - Country:US
Mailing Address - Phone:407-601-5308
Mailing Address - Fax:407-482-8698
Practice Address - Street 1:11616 LAKE UNDERHILL RD STE 205
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-4466
Practice Address - Country:US
Practice Address - Phone:407-601-5308
Practice Address - Fax:407-482-8698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty