Healthcare Provider Details

I. General information

NPI: 1770583528
Provider Name (Legal Business Name): INTERNAL MEDICINE SPECIALISTS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 12/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3885 OAKWATER CIR
ORLANDO FL
32806-6257
US

IV. Provider business mailing address

3885 OAKWATER CIR
ORLANDO FL
32806-6257
US

V. Phone/Fax

Practice location:
  • Phone: 407-851-5600
  • Fax: 407-438-9585
Mailing address:
  • Phone: 407-851-5600
  • Fax: 407-438-9585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: LISA G. BURDUE
Title or Position: PATIENT ACCOUNTS MANAGER
Credential:
Phone: 407-851-5600