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General NPI Number Information
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NPI Number | 1851766554
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Entity Type | Organization
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Legal Business Name | DIABETES NATIONAL ALLIANCE CLINIC
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Dates
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Enumeration Date | 12/07/2015
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Last Update Date | 03/29/2016
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Provider Practice Location Address
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Address Line | 13940 N US HIGHWAY 441 STE 801
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City | LADY LAKE
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State | FL
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Zip | 32159-8954
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Country | US
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Telephone | 352-414-7999
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Fax | 352-414-7998
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Provider Business Mailing Address
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Address Line | 13940 N US HIGHWAY 441 STE 801
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City | LADY LAKE
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State | FL
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Zip | 32159-8954
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Country | US
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Telephone | 352-414-7999
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Fax | 352-414-7998
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. GOPINATH SUNIL
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Credential | M.D.
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Telephone | 352-414-7999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | ME83396
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License Number State | FL
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