Provider Demographics
NPI:1477725083
Name:HUNTERS CREEK MEDICAL ASSOCIATES PA
Entity Type:Organization
Organization Name:HUNTERS CREEK MEDICAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:I
Authorized Official - Last Name:OTERO
Authorized Official - Suffix:
Authorized Official - Credentials:RMA
Authorized Official - Phone:407-943-8883
Mailing Address - Street 1:1178 CYPRESS GLEN CIRCLE
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741
Mailing Address - Country:US
Mailing Address - Phone:407-943-8883
Mailing Address - Fax:407-943-8854
Practice Address - Street 1:1178 CYPRESS GLEN CIRCLE
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741
Practice Address - Country:US
Practice Address - Phone:407-943-8883
Practice Address - Fax:407-943-8854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83295207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH50446Medicare UPIN