Healthcare Provider Details

I. General information

NPI: 1144132358
Provider Name (Legal Business Name): OPTIMA MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

379 W MICHIGAN ST STE 204
ORLANDO FL
32806-4466
US

IV. Provider business mailing address

3232 PLAYERS VIEW CIR
LONGWOOD FL
32779-3154
US

V. Phone/Fax

Practice location:
  • Phone: 407-775-2236
  • Fax: 407-794-4977
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: AJAYKUMAR R PATEL
Title or Position: PRESIDENT
Credential:
Phone: 407-775-2236