Provider Demographics
NPI:1982642922
Name:GASTRO-INTESTINAL CONSULTANTS OF CENTRAL FLORIDA, LLC
Entity Type:Organization
Organization Name:GASTRO-INTESTINAL CONSULTANTS OF CENTRAL FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LALBAHADUR
Authorized Official - Middle Name:S
Authorized Official - Last Name:NAGABHAIRU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-383-7703
Mailing Address - Street 1:PO BOX 1077
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32756-1077
Mailing Address - Country:US
Mailing Address - Phone:352-383-7703
Mailing Address - Fax:352-383-8875
Practice Address - Street 1:2060 N DONNELLY ST
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-2824
Practice Address - Country:US
Practice Address - Phone:352-383-7703
Practice Address - Fax:352-383-8875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8998Medicare ID - Type Unspecified