Provider Demographics
NPI:1811233505
Name:ASCENSION INTERNAL MEDICINE OF FLORIDA, LLC
Entity Type:Organization
Organization Name:ASCENSION INTERNAL MEDICINE OF FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MALIK
Authorized Official - Middle Name:M
Authorized Official - Last Name:NAQI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-208-0537
Mailing Address - Street 1:8924 SW 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-7014
Mailing Address - Country:US
Mailing Address - Phone:269-277-3536
Mailing Address - Fax:
Practice Address - Street 1:1426 CANYON AVE NE STE C
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064-4832
Practice Address - Country:US
Practice Address - Phone:386-208-0537
Practice Address - Fax:386-208-0571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-27
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008086300Medicaid