Healthcare Provider Details

I. General information

NPI: 1124300983
Provider Name (Legal Business Name): CENTRAL FLORIDA CANCER & BLOOD CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2011
Last Update Date: 10/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2494 SW 19TH AVENUE RD
OCALA FL
34471-7859
US

IV. Provider business mailing address

PO BOX 1988
OCALA FL
34478-1988
US

V. Phone/Fax

Practice location:
  • Phone: 352-671-4422
  • Fax: 352-671-4423
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberME93537
License Number StateFL

VIII. Authorized Official

Name: RAVI KOTI
Title or Position: OWNER
Credential: M.D.
Phone: 352-671-4422