MEDICARE: IAH OF FLORIDA, 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

General Provider Information

NPI Number	:	1750787982
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IAH OF FLORIDA, LLC

Provider Business Mailing Address
First Line	:	PO BOX 40548
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-1256
Country	:	US
Telephone Number	:	248-824-6600
Fax Number	:	855-618-6655

Provider Business Practice Location Address
First Line	:	5011 GATE PARKWAY BLD 100 STE 350
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-0830
Country	:	US
Telephone Number	:	904-281-1915
Fax Number	:	904-281-1119

Authorized Official
Title or Position	:	CFO
Name	:	ZACHARY MULLIGAN
Credential	:
Telephone Number	:	248-824-6600

Provider Enumeration Date	:	11/17/2014
Last Update Date	:	12/23/2025

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Directions to “IAH OF FLORIDA, LLC ” Practice Location

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