| Florida Internal Medicine, Pl | |
|
620 S Lake St Suite# 6 Leesburg FL 34748-6059 | |
| (352) 365-0099 | |
| (352) 315-0578 |
| Full Name | Florida Internal Medicine, Pl |
|---|---|
| Speciality | Internal Medicine |
| Location | 620 S Lake St, Leesburg, Florida |
| Authorized Official Name and Position | Dwaraknadh R Banala (OWNER) |
| Authorized Official Contact | 3523650099 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Florida Internal Medicine, Pl 3016 Palermo Ct Mount Dora FL 32757-6527 Ph: (352) 383-8209 | Florida Internal Medicine, Pl 620 S Lake St Suite# 6 Leesburg FL 34748-6059 Ph: (352) 365-0099 |
| NPI Number | 1912954439 |
|---|---|
| Provider Enumeration Date | 05/29/2006 |
| Last Update Date | 01/10/2011 |
| Medicare PECOS PAC ID | 5294769139 |
|---|---|
| Medicare Enrollment ID | O20050921000160 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912954439 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | ME80590 (Florida) | Primary |
| Provider Name | Dwaraknadh R Banala |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1437106614 PECOS PAC ID: 5193764033 Enrollment ID: I20050922000404 |
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