Provider Demographics
NPI:1669813135
Name:LITTLE ANGEL SILVER STAR LLC
Entity Type:Organization
Organization Name:LITTLE ANGEL SILVER STAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICAHEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KERKES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-512-5700
Mailing Address - Street 1:4614 S KIRKMAN RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-2891
Mailing Address - Country:US
Mailing Address - Phone:407-512-5700
Mailing Address - Fax:800-752-1493
Practice Address - Street 1:4614 S KIRKMAN RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-2891
Practice Address - Country:US
Practice Address - Phone:407-512-5700
Practice Address - Fax:800-752-1493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME44739207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty