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General NPI Number Information
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NPI Number | 1215508833
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Entity Type | Organization
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Legal Business Name | SIDVIN PRIMARY CARE PLLC
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Dates
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Enumeration Date | 07/06/2021
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Last Update Date | 07/06/2021
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Provider Practice Location Address
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Address Line | 7558 SW 61ST AVE STE 1
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City | OCALA
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State | FL
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Zip | 34476-8323
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Country | US
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Telephone | 352-553-6746
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Fax |
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Provider Business Mailing Address
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Address Line | 7558 SW 61ST AVE STE 1
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City | OCALA
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State | FL
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Zip | 34476-8323
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Country | US
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Telephone | 352-553-6746
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Fax |
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Authorized Official
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Title or Position | SOLE PARTNER
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Name | AMARAVADI KAMALAKAR
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Credential | MD
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Telephone | 352-553-6746
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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