Healthcare Provider Details

I. General information

NPI: 1073576146
Provider Name (Legal Business Name): MEDICAL VENTURES OF AMERICA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16890 US HIGHWAY 441
MOUNT DORA FL
32757-6705
US

IV. Provider business mailing address

16890 US HIGHWAY 441
MOUNT DORA FL
32757-6705
US

V. Phone/Fax

Practice location:
  • Phone: 352-250-5546
  • Fax:
Mailing address:
  • Phone: 352-250-5546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: MARK DELEGGE
Title or Position: OWNER
Credential: MD
Phone: 843-697-0400