Provider Demographics
NPI:1972069946
Name:MID-FLORIDA RHEUMATOLOGY LLC
Entity Type:Organization
Organization Name:MID-FLORIDA RHEUMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:KWABENA
Authorized Official - Middle Name:
Authorized Official - Last Name:AYESU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-668-4202
Mailing Address - Street 1:1743 PARK CENTER DR STE 400
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-7621
Mailing Address - Country:US
Mailing Address - Phone:386-668-4202
Mailing Address - Fax:386-668-4207
Practice Address - Street 1:1743 PARK CENTER DR STE 400
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-7621
Practice Address - Country:US
Practice Address - Phone:386-668-4202
Practice Address - Fax:386-668-4207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-14
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty