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General NPI Number Information
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NPI Number | 1275702037
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Entity Type | Organization
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Legal Business Name | MIDFLORIDA INTERNAL MEDICINE ASSOCIATES, PA
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Dates
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Enumeration Date | 02/26/2008
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Last Update Date | 02/17/2015
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Provider Practice Location Address
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Address Line | 675 AVENUE L SE
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City | WINTER HAVEN
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State | FL
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Zip | 33880-4219
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Country | US
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Telephone | 863-293-9500
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Fax | 863-293-9511
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Provider Business Mailing Address
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Address Line | 320 1ST ST N
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City | WINTER HAVEN
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State | FL
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Zip | 33881-4113
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Country | US
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Telephone | 863-293-9500
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Fax | 863-293-4994
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Authorized Official
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Title or Position | CONTRACTING/CREDENTIALING
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Name | MISS STEPHANIE N NALKER
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Credential |
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Telephone | 863-293-9500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME0068923
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License Number State | FL
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