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General NPI Number Information
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NPI Number | 1376233346
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Entity Type | Organization
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Legal Business Name | ORLANDO PRIMARY MEDICINE, LLC
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Dates
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Enumeration Date | 05/11/2023
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Last Update Date | 05/11/2023
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Provider Practice Location Address
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Address Line | 11616 LAKE UNDERHILL RD STE 205
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City | ORLANDO
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State | FL
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Zip | 32825-4466
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Country | US
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Telephone | 407-601-5308
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Fax | 407-482-8698
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Provider Business Mailing Address
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Address Line | 11616 LAKE UNDERHILL RD STE 215
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City | ORLANDO
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State | FL
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Zip | 32825-4465
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Country | US
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Telephone | 407-601-5308
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Fax | 407-482-8698
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Authorized Official
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Title or Position | MANAGER
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Name | VINEEL SOMPALLI
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Credential | MD
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Telephone | 407-482-7788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice 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 | 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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