MEDICARE: PRIMARY CARE OF ORLANDO, INC.

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	ME71184	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	:	1932221504
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMARY CARE OF ORLANDO, INC.

Provider Business Mailing Address
First Line	:	5308 S JOHN YOUNG PKWY
Second Line	:	SUITE 100
City	:	ORLANDO
State	:	FL
Zip	:	32839-7362
Country	:	US
Telephone Number	:	407-857-2144
Fax Number	:	407-857-9366

Provider Business Practice Location Address
First Line	:	5308 S JOHN YOUNG PKWY
Second Line	:	SUITE 100
City	:	ORLANDO
State	:	FL
Zip	:	32839-7362
Country	:	US
Telephone Number	:	407-857-2144
Fax Number	:	407-857-9366

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JASEEM A KHAN
Credential	:	MD
Telephone Number	:	407-857-2144

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	11/07/2012

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