Healthcare Provider Details

I. General information

NPI: 1912980632
Provider Name (Legal Business Name): PRIMARY CARE SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 11/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3615 S ORANGE AVE
ORLANDO FL
32806-6216
US

IV. Provider business mailing address

3615 S ORANGE AVE
ORLANDO FL
32806-6216
US

V. Phone/Fax

Practice location:
  • Phone: 407-855-2526
  • Fax: 407-855-1503
Mailing address:
  • Phone: 407-855-2526
  • Fax: 407-855-1503

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