Healthcare Provider Details

I. General information

NPI: 1619257961
Provider Name (Legal Business Name): FAMILY INTERNAL MEDICINE OF OCALA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2011
Last Update Date: 05/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1623 SW 1ST AVE
OCALA FL
34471-6528
US

IV. Provider business mailing address

1623 SW 1ST AVE
OCALA FL
34471-6528
US

V. Phone/Fax

Practice location:
  • Phone: 352-732-9844
  • Fax: 352-351-4305
Mailing address:
  • Phone: 352-732-9844
  • Fax: 352-351-4305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: KUCHAKULLA N REDDY
Title or Position: TREASURER
Credential: MD
Phone: 352-732-9844