Healthcare Provider Details

I. General information

NPI: 1871558973
Provider Name (Legal Business Name): MEDICAL VILLAGE HOLDINGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1462 W OAK RIDGE ROAD
ORLANDO FL
32809
US

IV. Provider business mailing address

816 W OAK STREET
KISSIMMEE FL
34741
US

V. Phone/Fax

Practice location:
  • Phone: 407-770-0078
  • Fax: 407-888-3310
Mailing address:
  • Phone: 407-944-9777
  • Fax: 407-944-9796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KHALID MANZUR
Title or Position: PRESIDENT
Credential: MD
Phone: 321-662-3821