Provider Demographics
NPI:1629816459
Name:OPTUMMD LLC
Entity type:Organization
Organization Name:OPTUMMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ESPINOSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-257-5585
Mailing Address - Street 1:91 W WIEUCA RD NE STE 1000
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-3289
Mailing Address - Country:US
Mailing Address - Phone:404-257-5585
Mailing Address - Fax:404-257-9985
Practice Address - Street 1:91 W WIEUCA RD NE STE 1000
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-3289
Practice Address - Country:US
Practice Address - Phone:404-257-5585
Practice Address - Fax:404-257-9985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-16
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty