MEDICARE: AMERI MINDCARE PA

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	2084P0804X	Child & Adolescent Psychiatry Physician	ME93520	FL
2	2084P0800X	Psychiatry Physician	ME93520	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	38008	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215193859
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERI MINDCARE PA

Provider Business Mailing Address
First Line	:	3389 W VINE ST
Second Line	:	SUITE 304
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-4665
Country	:	US
Telephone Number	:	407-932-2799
Fax Number	:	407-932-0303

Provider Business Practice Location Address
First Line	:	3389 W VINE ST
Second Line	:	SUITE 304
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-4665
Country	:	US
Telephone Number	:	407-932-2799
Fax Number	:	407-932-0303

Authorized Official
Title or Position	:	PSYCHIATRIST
Name	:	DR. RAMARAO MAKKENA
Credential	:	MD
Telephone Number	:	407-932-2799

Provider Enumeration Date	:	08/04/2008
Last Update Date	:	10/31/2013

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Directions to “AMERI MINDCARE PA ” Practice Location

Language	Start Address	Practice Location

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