Provider Demographics
NPI:1821491895
Name:OCALA MEDICAL AND INFECTIOUS DISEASE ASSOCIATES PA
Entity Type:Organization
Organization Name:OCALA MEDICAL AND INFECTIOUS DISEASE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:I
Authorized Official - Last Name:SOOSAIPILLAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-622-2020
Mailing Address - Street 1:3306 SW 26TH AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-7856
Mailing Address - Country:US
Mailing Address - Phone:352-622-2020
Mailing Address - Fax:352-622-2025
Practice Address - Street 1:3306 SW 26TH AVE
Practice Address - Street 2:STE 104
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-7856
Practice Address - Country:US
Practice Address - Phone:352-622-2020
Practice Address - Fax:352-622-2025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-03
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013502700Medicaid
FL008N8OtherBCBS OF FLORIDA
FL008N8OtherBCBS OF FLORIDA