Provider Demographics
NPI:1790015717
Name:ASSOCIATES IN GERIATRIC MEDICINE LLC
Entity type:Organization
Organization Name:ASSOCIATES IN GERIATRIC MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICEMANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PRASAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KASIREDDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-490-4362
Mailing Address - Street 1:6503 PLANTATION PRESERVE CIR N
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-8366
Mailing Address - Country:US
Mailing Address - Phone:727-798-0482
Mailing Address - Fax:
Practice Address - Street 1:6503 PLANTATION PRESERVE CIR N
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-8366
Practice Address - Country:US
Practice Address - Phone:727-798-0482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-14
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty