Provider Demographics
NPI:1942433883
Name:FAMILY & INTERNAL MEDICINE ASSOCIATES PA
Entity Type:Organization
Organization Name:FAMILY & INTERNAL MEDICINE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:ZOLKOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-721-1900
Mailing Address - Street 1:7915 US 301 HWY N
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ELLENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34222-3531
Mailing Address - Country:US
Mailing Address - Phone:941-721-1900
Mailing Address - Fax:941-721-3600
Practice Address - Street 1:7915 US 301 HWY N
Practice Address - Street 2:SUITE 103
Practice Address - City:ELLENTON
Practice Address - State:FL
Practice Address - Zip Code:34222-3531
Practice Address - Country:US
Practice Address - Phone:941-721-1900
Practice Address - Fax:941-721-3600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-26
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME104700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME104700OtherLICENSE NUMBER