Healthcare Provider Details

I. General information

NPI: 1548345226
Provider Name (Legal Business Name): PRIMARY CARE SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 09/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 S ORANGE AVE SUITE 105
ORLANDO FL
32806-2944
US

IV. Provider business mailing address

4711 CURRY FORD RD
ORLANDO FL
32812-2704
US

V. Phone/Fax

Practice location:
  • Phone: 407-351-5384
  • Fax: 407-843-2109
Mailing address:
  • Phone: 407-275-9014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GERALD J KIVETT
Title or Position: PARTNER
Credential: MD
Phone: 407-275-9014