Provider Demographics
NPI:1841631363
Name:ADVANCED MED PARTNERS LLC
Entity type:Organization
Organization Name:ADVANCED MED PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MADHAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:JAKKULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-384-1718
Mailing Address - Street 1:PO BOX 940220
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32794-0220
Mailing Address - Country:US
Mailing Address - Phone:407-384-1718
Mailing Address - Fax:407-384-1806
Practice Address - Street 1:7824 LAKE UNDERHILL RD
Practice Address - Street 2:SUITE H
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8201
Practice Address - Country:US
Practice Address - Phone:407-282-0059
Practice Address - Fax:407-384-1806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-12
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty