Provider Demographics
NPI:1851766554
Name:DIABETES NATIONAL ALLIANCE CLINIC
Entity Type:Organization
Organization Name:DIABETES NATIONAL ALLIANCE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GOPINATH
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-414-7999
Mailing Address - Street 1:13940 N US HIGHWAY 441 STE 801
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-8954
Mailing Address - Country:US
Mailing Address - Phone:352-414-7999
Mailing Address - Fax:352-414-7998
Practice Address - Street 1:13940 N US HIGHWAY 441 STE 801
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-8954
Practice Address - Country:US
Practice Address - Phone:352-414-7999
Practice Address - Fax:352-414-7998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-07
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83396207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty