Healthcare Provider Details

I. General information

NPI: 1821491895
Provider Name (Legal Business Name): OCALA MEDICAL AND INFECTIOUS DISEASE ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2014
Last Update Date: 03/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3306 SW 26TH AVE STE 104
OCALA FL
34471-7856
US

IV. Provider business mailing address

3306 SW 26TH AVE STE 104
OCALA FL
34471-7856
US

V. Phone/Fax

Practice location:
  • Phone: 352-622-2020
  • Fax: 352-622-2025
Mailing address:
  • Phone: 352-622-2020
  • Fax: 352-622-2025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: IVAN I SOOSAIPILLAI
Title or Position: OWNER
Credential: M.D.
Phone: 352-622-2020