Provider Demographics
NPI:1790730927
Name:ORLANDO CENTER FOR INTERNAL MEDICINE & PRIMARY CARE PA
Entity Type:Organization
Organization Name:ORLANDO CENTER FOR INTERNAL MEDICINE & PRIMARY CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:DENESE
Authorized Official - Last Name:COKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-296-1925
Mailing Address - Street 1:10000 W COLONIAL DR
Mailing Address - Street 2:SUITE 487
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-3498
Mailing Address - Country:US
Mailing Address - Phone:407-296-1925
Mailing Address - Fax:407-445-5550
Practice Address - Street 1:10000 W COLONIAL DR
Practice Address - Street 2:SUITE 487
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-3498
Practice Address - Country:US
Practice Address - Phone:407-296-1925
Practice Address - Fax:407-445-5550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL33473Medicare PIN