Healthcare Provider Details

I. General information

NPI: 1316977259
Provider Name (Legal Business Name): APOPKA MEDICAL GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 S PARK AVE
APOPKA FL
32703-4254
US

IV. Provider business mailing address

PO BOX 1107
APOPKA FL
32704-1107
US

V. Phone/Fax

Practice location:
  • Phone: 407-886-1171
  • Fax: 407-886-8386
Mailing address:
  • Phone: 407-886-1171
  • Fax: 407-886-8386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberME0055219
License Number StateFL

VIII. Authorized Official

Name: MRS. INGRID BEHNER
Title or Position: OFFICE MANAGER
Credential:
Phone: 407-886-1171