| Davenport Medical Center Llc | |
|
2502 Sand Mine Rd Davenport FL 33897-3402 | |
| (863) 420-4077 | |
| (863) 420-4087 |
| Full Name | Davenport Medical Center Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2502 Sand Mine Rd, Davenport, Florida |
| Authorized Official Name and Position | Aftab Khan (OWNER) |
| Authorized Official Contact | 8634204077 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Davenport Medical Center Llc Po Box 22927 Orlando FL 32830-2927 Ph: (863) 420-4077 | Davenport Medical Center Llc 2502 Sand Mine Rd Davenport FL 33897-3402 Ph: (863) 420-4077 |
| NPI Number | 1144306036 |
|---|---|
| Provider Enumeration Date | 10/31/2006 |
| Last Update Date | 04/18/2011 |
| Medicare PECOS PAC ID | 4789677303 |
|---|---|
| Medicare Enrollment ID | O20040407001233 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144306036 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | ME86482 (Florida) | Primary |
| Provider Name | Aftab A Khan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699851584 PECOS PAC ID: 9739172354 Enrollment ID: I20040408000858 |
| Provider Name | Kataceya Angela Lamanna |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245709740 PECOS PAC ID: 5799027173 Enrollment ID: I20190506000752 |
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