Provider Demographics
NPI:1740088780
Name:INTERNAL MEDICINE AT DEBARY LLC
Entity type:Organization
Organization Name:INTERNAL MEDICINE AT DEBARY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
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:407-493-3983
Mailing Address - Street 1:615 N CHARLES RICHARD BEALL BLVD
Mailing Address - Street 2:
Mailing Address - City:DEBARY
Mailing Address - State:FL
Mailing Address - Zip Code:32713-2266
Mailing Address - Country:US
Mailing Address - Phone:386-210-9402
Mailing Address - Fax:
Practice Address - Street 1:615 N CHARLES RICHARD BEALL BLVD
Practice Address - Street 2:
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-2266
Practice Address - Country:US
Practice Address - Phone:386-210-9402
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty