Provider Demographics
NPI:1811137672
Name:MEDICAL ASSOCIATES, P.A.
Entity type:Organization
Organization Name:MEDICAL ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:IRFAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDDIQUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-944-1800
Mailing Address - Street 1:200 N JOHN YOUNG PKWY
Mailing Address - Street 2:STE 101
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-6601
Mailing Address - Country:US
Mailing Address - Phone:407-944-1800
Mailing Address - Fax:
Practice Address - Street 1:200 N JOHN YOUNG PKWY
Practice Address - Street 2:STE 101
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-6601
Practice Address - Country:US
Practice Address - Phone:407-944-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70992207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250988100Medicaid
FLG37586Medicare UPIN
FL31675Medicare PIN