MEDICARE: NANDRA FAMILY PHYSICIANS 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
1	207Q00000X	Family Medicine Physician	ME85696	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093788341
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NANDRA FAMILY PHYSICIANS LLC

Provider Business Mailing Address
First Line	:	PO BOX 952739
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32795-2739
Country	:	US
Telephone Number	:	407-921-2074
Fax Number	:	321-363-1735

Provider Business Practice Location Address
First Line	:	5840 W COLONIAL DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32808-7558
Country	:	US
Telephone Number	:	407-292-2200
Fax Number	:	407-292-8210

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. HARMINDER K NANDRA
Credential	:
Telephone Number	:	407-921-2074

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	05/13/2009

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