Provider Demographics
NPI:1811940539
Name:ALLIANCE OBSTETRICS & GYNECOLOGY PA
Entity type:Organization
Organization Name:ALLIANCE OBSTETRICS & GYNECOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAZMIERCZAK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:352-241-4444
Mailing Address - Street 1:PO BOX 120455
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34712-0455
Mailing Address - Country:US
Mailing Address - Phone:352-241-4444
Mailing Address - Fax:352-241-4245
Practice Address - Street 1:835 7TH ST
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2156
Practice Address - Country:US
Practice Address - Phone:352-241-4444
Practice Address - Fax:352-241-4245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 9573207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9746Medicare ID - Type Unspecified