Healthcare Provider Details

I. General information

NPI: 1932640539
Provider Name (Legal Business Name): ADVANTAGE MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2017
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 E VINE ST STE 1
KISSIMMEE FL
34744-4232
US

IV. Provider business mailing address

715 E VINE ST STE 1
KISSIMMEE FL
34744-4232
US

V. Phone/Fax

Practice location:
  • Phone: 407-930-1112
  • Fax: 407-930-1114
Mailing address:
  • Phone: 407-930-1112
  • Fax: 407-930-1114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: DR. ARCILIO ALVARADO
Title or Position: CEO
Credential: M.D
Phone: 787-306-8356