Provider Demographics
NPI:1457590721
Name:CENTRAL FLORIDA INFECTIOUS DISEASES LLC
Entity Type:Organization
Organization Name:CENTRAL FLORIDA INFECTIOUS DISEASES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:MATHEW
Authorized Official - Last Name:JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-718-8329
Mailing Address - Street 1:11321 LAUREL BROOK CT
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-2023
Mailing Address - Country:US
Mailing Address - Phone:254-718-8329
Mailing Address - Fax:863-583-8555
Practice Address - Street 1:200 AVENUE F SW
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-3432
Practice Address - Country:US
Practice Address - Phone:863-293-1121
Practice Address - Fax:863-291-6028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99435207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAF207ZMedicare UPIN