Provider Demographics
NPI:1639474364
Name:SINAI INTERNAL MEDICINE SPECIALISTS
Entity Type:Organization
Organization Name:SINAI INTERNAL MEDICINE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:DR
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:C
Authorized Official - Last Name:AGBO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-753-2224
Mailing Address - Street 1:910 OLD CAMP RD
Mailing Address - Street 2:BLDG 140, SUITE 144
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-5604
Mailing Address - Country:US
Mailing Address - Phone:352-753-2224
Mailing Address - Fax:352-753-0833
Practice Address - Street 1:910 OLD CAMP RD
Practice Address - Street 2:BLDG 140 SUITE 144
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-5604
Practice Address - Country:US
Practice Address - Phone:352-753-2224
Practice Address - Fax:352-753-0833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-11
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98905207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL16240OtherBLUE CROSS BLUE SHIELD
FL279208700Medicaid
FLAI535YMedicare PIN