| Burgundy Prime Inc | |
|
430 Waymont Ct Ste 100 Lake Mary FL 32746-6745 | |
| (407) 878-0022 | |
| (407) 369-4267 |
| Full Name | Burgundy Prime Inc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 430 Waymont Ct Ste 100, Lake Mary, Florida |
| Authorized Official Name and Position | Abid Malik (PRESIDENT) |
| Authorized Official Contact | 4077778084 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Burgundy Prime Inc 430 Waymont Ct Ste 100 Lake Mary FL 32746-6745 Ph: (407) 878-0022 | Burgundy Prime Inc 430 Waymont Ct Ste 100 Lake Mary FL 32746-6745 Ph: (407) 878-0022 |
| NPI Number | 1720557150 |
|---|---|
| Provider Enumeration Date | 11/14/2018 |
| Last Update Date | 11/14/2018 |
| Medicare PECOS PAC ID | 3870835507 |
|---|---|
| Medicare Enrollment ID | O20190430000934 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720557150 | NPI | - | NPPES |
| Provider Name | Abid Malik |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1922122035 PECOS PAC ID: 8426130162 Enrollment ID: I20100819000139 |
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