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2110 N Donnelly St Ste 200 Mount Dora FL 32757-6967 | |
| (352) 735-8231 | |
| (903) 957-3195 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 2110 N Donnelly St Ste 200, Mount Dora, Florida |
| Authorized Official Name and Position | Jonathan Leizman (PRESIDENT) |
| Authorized Official Contact | 2164799063 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
5500 Maryland Way Brentwood TN 37027-7048 Ph: () - | 2110 N Donnelly St Ste 200 Mount Dora FL 32757-6967 Ph: (352) 735-8231 |
| NPI Number | 1386318434 |
|---|---|
| Provider Enumeration Date | 08/03/2021 |
| Last Update Date | 08/09/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386318434 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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