Provider Demographics
NPI:1295749141
Name:ORLANDO MEDICAL GROUP LLC
Entity type:Organization
Organization Name:ORLANDO MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:INDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMLACHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-241-0037
Mailing Address - Street 1:841 OAKLEY SEAVER DRIVE
Mailing Address - Street 2:UNIT A
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-1971
Mailing Address - Country:US
Mailing Address - Phone:352-241-0037
Mailing Address - Fax:352-241-0067
Practice Address - Street 1:841 OAKLEY SEAVER DRIVE
Practice Address - Street 2:UNIT A
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1971
Practice Address - Country:US
Practice Address - Phone:352-241-0037
Practice Address - Fax:352-241-0067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273904600Medicaid
FL273904600Medicaid
FL273904600Medicaid
U6167ZMedicare PIN