Provider Demographics
NPI:1508097759
Name:GEORGE R IKELER, M.D P.A.
Entity Type:Organization
Organization Name:GEORGE R IKELER, M.D P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:IKELER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-735-4044
Mailing Address - Street 1:31450 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SORRENTO
Mailing Address - State:FL
Mailing Address - Zip Code:32776-9594
Mailing Address - Country:US
Mailing Address - Phone:352-735-4044
Mailing Address - Fax:352-735-2536
Practice Address - Street 1:31450 CHURCH ST
Practice Address - Street 2:
Practice Address - City:SORRENTO
Practice Address - State:FL
Practice Address - Zip Code:32776-9594
Practice Address - Country:US
Practice Address - Phone:352-735-4044
Practice Address - Fax:352-735-2536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME12314261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL043349700Medicaid
FL108955Medicare Oscar/Certification
FL043349700Medicaid
FLCC848AMedicare Oscar/Certification