Provider Demographics
NPI:1417419490
Name:MEDIPRO HEALTH LLC
Entity Type:Organization
Organization Name:MEDIPRO HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAVEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:516-270-5873
Mailing Address - Street 1:581 N PARK AVE UNIT 4128
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32704-8731
Mailing Address - Country:US
Mailing Address - Phone:407-537-2767
Mailing Address - Fax:
Practice Address - Street 1:1475 W ORANGE BLOSSOM TRL
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712-2828
Practice Address - Country:US
Practice Address - Phone:407-537-2767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty