Provider Demographics
NPI:1821218280
Name:ANDERSON, HARLEEN K (MD)
Entity Type:Individual
Prefix:DR
First Name:HARLEEN
Middle Name:K
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:HARLEEN
Other - Middle Name:K
Other - Last Name:AHLUWALIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1890 STATE ROAD 436
Mailing Address - Street 2:SUITE 215
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-2228
Mailing Address - Country:US
Mailing Address - Phone:407-678-4040
Mailing Address - Fax:407-678-6935
Practice Address - Street 1:1890 STATE ROAD 436
Practice Address - Street 2:SUITE 215
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-2228
Practice Address - Country:US
Practice Address - Phone:407-678-4040
Practice Address - Fax:407-678-6935
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL26020207RA0201X
FLME110856207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006612700Medicaid
000211901Medicare PIN
FLGN048ZMedicare PIN