Provider Demographics
NPI:1568903482
Name:FLORIDIAN MEDICAL GROUP INC
Entity Type:Organization
Organization Name:FLORIDIAN MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRASURE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-744-1130
Mailing Address - Street 1:804 EMMETT ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5434
Mailing Address - Country:US
Mailing Address - Phone:407-449-4559
Mailing Address - Fax:
Practice Address - Street 1:804 EMMETT ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5434
Practice Address - Country:US
Practice Address - Phone:407-449-4559
Practice Address - Fax:407-588-8626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-10
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBTR-09881174400000X
208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty