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390 Baymoor Way Lake Mary FL 32746-7023 | |
| (321) 458-7014 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 390 Baymoor Way, Lake Mary, Florida |
| Authorized Official Name and Position | Faiza Faisal (OFFICE MANAGER) |
| Authorized Official Contact | 4075456232 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
390 Baymoor Way Lake Mary FL 32746-7023 Ph: (321) 458-7014 | 390 Baymoor Way Lake Mary FL 32746-7023 Ph: (321) 458-7014 |
| NPI Number | 1922649367 |
|---|---|
| Provider Enumeration Date | 10/07/2019 |
| Last Update Date | 10/25/2024 |
| Medicare PECOS PAC ID | 8921431891 |
|---|---|
| Medicare Enrollment ID | O20191206000743 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922649367 | NPI | - | NPPES |
| Provider Name | Paulette A Smart-mackey |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1730366626 PECOS PAC ID: 5698769867 Enrollment ID: I20040413000260 |
| Provider Name | James K Shea |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1144385287 PECOS PAC ID: 6305730532 Enrollment ID: I20120321000254 |
| Provider Name | Christopher Kempf |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033461603 PECOS PAC ID: 1850545625 Enrollment ID: I20130201000099 |
| Provider Name | Erin Mcmillan Werner |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1477864601 PECOS PAC ID: 6608016670 Enrollment ID: I20130716000373 |
| Provider Name | Rahul Pathak |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1487819413 PECOS PAC ID: 7113071614 Enrollment ID: I20141204000349 |
| Provider Name | Lourdes Martinez Brenes |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1396186961 PECOS PAC ID: 2264712702 Enrollment ID: I20161129002143 |
| Provider Name | Umair Khan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1255746426 PECOS PAC ID: 2769766245 Enrollment ID: I20170830003272 |
| Provider Name | Satish B Chandolu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1053604124 PECOS PAC ID: 7012131139 Enrollment ID: I20180620003336 |
| Provider Name | Maria Del C Martinez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1033319058 PECOS PAC ID: 7113065053 Enrollment ID: I20180914002458 |
| Provider Name | Mohammed Munim |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1528435070 PECOS PAC ID: 0547521668 Enrollment ID: I20181212000594 |
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