Provider Demographics
NPI:1407306806
Name:MEDICAL ASSOCIATES OF GREATER ORLANDO
Entity Type:Organization
Organization Name:MEDICAL ASSOCIATES OF GREATER ORLANDO
Other - Org Name:INNOVATIVE EXPRESS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DOCTOR / PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRASHANT
Authorized Official - Middle Name:
Authorized Official - Last Name:JANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-986-0650
Mailing Address - Street 1:1115 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4405
Mailing Address - Country:US
Mailing Address - Phone:407-986-0650
Mailing Address - Fax:407-930-4632
Practice Address - Street 1:3014 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-1542
Practice Address - Country:US
Practice Address - Phone:407-986-0650
Practice Address - Fax:407-930-4632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-10
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME114445207R00000X
FL9101079363AM0700X
FLARNP9214160363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty