MEDICARE: INFECTIOUS DISEASES OF MID-FLORIDA, 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	207R00000X	Internal Medicine Physician	ME86706	FL
2	207RI0200X	Infectious Disease Physician	ME86706	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
2	78720	OTHER	FL	BC OF FL

General Provider Information

NPI Number	:	1396837308
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INFECTIOUS DISEASES OF MID-FLORIDA, PA

Provider Business Mailing Address
First Line	:	PO BOX 730606
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32173-0606
Country	:	US
Telephone Number	:	386-265-1021
Fax Number	:	386-265-1033

Provider Business Practice Location Address
First Line	:	290 CLYDE MORRIS BLVD STE D2
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-8204
Country	:	US
Telephone Number	:	386-265-1021
Fax Number	:	386-265-1033

Authorized Official
Title or Position	:	PROVIDER
Name	:	UKONU OKORO EJIE
Credential	:	M.D.
Telephone Number	:	386-265-1021

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	10/31/2025

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