Provider Demographics
NPI:1376586081
Name:ORLANDO INTERNAL MEDICINE PA
Entity Type:Organization
Organization Name:ORLANDO INTERNAL MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:AKELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-445-9545
Mailing Address - Street 1:1507 S HIAWASSEE RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-5718
Mailing Address - Country:US
Mailing Address - Phone:407-445-9545
Mailing Address - Fax:407-445-9365
Practice Address - Street 1:1507 S HIAWASSEE RD
Practice Address - Street 2:SUITE 107
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-5718
Practice Address - Country:US
Practice Address - Phone:407-445-9545
Practice Address - Fax:407-445-9365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261609200Medicaid
FL261609200Medicaid
FLG89136Medicare UPIN
FLH07592Medicare UPIN
G60040Medicare UPIN