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NPI Code Detail

MEDICARE: MEDICAL VENTURES OF AMERICA LLC

MEDICARE: MEDICAL VENTURES OF AMERICA LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1173000000XLegal Medicine

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
110D1004910OTHERFLMEDICARE CLIA #

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
234537OTHERFLBLUE GRP PROV #
3B902BOTHERFLBLUE SHIELD FACILITY #
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1073576146
Entity Type Code : Organization
Provider Name (Legal Business Name) : MEDICAL VENTURES OF AMERICA LLC
Provider Business Mailing Address
First Line : 16890 US HIGHWAY 441
Second Line :
City : MOUNT DORA
State : FL
Zip : 32757-6705
Country : US
Telephone Number : 352-250-5546
Fax Number :
Provider Business Practice Location Address
First Line : 16890 US HIGHWAY 441
Second Line :
City : MOUNT DORA
State : FL
Zip : 32757-6705
Country : US
Telephone Number : 352-250-5546
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MARK DELEGGE
Credential : MD
Telephone Number : 843-697-0400
Provider Enumeration Date : 04/10/2006
Last Update Date : 03/03/2025

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Directions to “MEDICAL VENTURES OF AMERICA LLC ” Practice Location

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