Provider Demographics
NPI:1932221504
Name:PRIMARY CARE OF ORLANDO, INC.
Entity Type:Organization
Organization Name:PRIMARY CARE OF ORLANDO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASEEM
Authorized Official - Middle Name:A
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-857-2144
Mailing Address - Street 1:5308 S JOHN YOUNG PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-7362
Mailing Address - Country:US
Mailing Address - Phone:407-857-2144
Mailing Address - Fax:407-857-9366
Practice Address - Street 1:5308 S JOHN YOUNG PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-7362
Practice Address - Country:US
Practice Address - Phone:407-857-2144
Practice Address - Fax:407-857-9366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71184207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250895800Medicaid
FLG42255Medicare UPIN
FL250895800Medicaid