| Infectious Diseases Of Mid-florida, Pa | |
|
104 Lacosta Ln Ste 120 Daytona Beach FL 32114-8160 | |
| (386) 274-1966 | |
| (386) 274-1964 |
| Full Name | Infectious Diseases Of Mid-florida, Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 104 Lacosta Ln Ste 120, Daytona Beach, Florida |
| Authorized Official Name and Position | Ukonu Okoro Ejie (PROVIDER) |
| Authorized Official Contact | 3862741966 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Infectious Diseases Of Mid-florida, Pa 104 Lacosta Ln Ste 120 Daytona Beach FL 32114-8160 Ph: (386) 274-1966 | Infectious Diseases Of Mid-florida, Pa 104 Lacosta Ln Ste 120 Daytona Beach FL 32114-8160 Ph: (386) 274-1966 |
| NPI Number | 1396837308 |
|---|---|
| Provider Enumeration Date | 09/28/2006 |
| Last Update Date | 02/15/2019 |
| Medicare PECOS PAC ID | 9032123526 |
|---|---|
| Medicare Enrollment ID | O20060206000052 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396837308 | NPI | - | NPPES |
| 266737100 | Medicaid | FL | |
| 78720 | Other | FL | BC OF FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | ME86706 (Florida) | Secondary |
| 207RI0200X | Internal Medicine - Infectious Disease | ME86706 (Florida) | Primary |
| Provider Name | Franklyn F Dontfraid |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1447243423 PECOS PAC ID: 7315974847 Enrollment ID: I20050727000136 |
| Provider Name | Ukonu O Ejie |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1790761500 PECOS PAC ID: 5395759880 Enrollment ID: I20060207000162 |
| Provider Name | Ronald S Rusiecki |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1487859955 PECOS PAC ID: 5092851337 Enrollment ID: I20090930000262 |
| Provider Name | Akshay Manohar |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1124314703 PECOS PAC ID: 9638452386 Enrollment ID: I20170203001620 |
| Provider Name | Lisa Bryan Ukawuilulu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316416076 PECOS PAC ID: 2961743760 Enrollment ID: I20190404000415 |
| Provider Name | Amber Dawnette Wright |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962969147 PECOS PAC ID: 3779919428 Enrollment ID: I20200129000295 |
Primecare Acquisition Family Practice Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1890 Lpga Blvd Ste 130, Daytona Beach, FL 32117 Phone: 386-274-2212 Fax: 386-274-1508 | |
Alexandra Crossman Md Pa Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 303 N Clyde Morris Blvd, Daytona Beach, FL 32114 Phone: 386-589-5741 | |
Kemshol Medical Center Pa Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 984 Orange Ave, Daytona Beach, FL 32114 Phone: 386-226-3008 Fax: 386-226-3044 | |
Adventhealth Centra Care - Daytona Beach Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1014 W International Speedway Blvd, Daytona Beach, FL 32114 Phone: 407-200-2300 Fax: 407-200-1353 | |
Primary Healthcare Alliance Foundation Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1445 Dunn Ave Ste B, Daytona Beach, FL 32114 Phone: 386-238-9527 Fax: 386-492-5059 | |
Volusia Hospitalist Plc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 301 Memorial Medical Pkwy, Daytona Beach, FL 32117 Phone: 386-676-0255 Fax: 386-676-2555 | |
Premier Infectious Disease Consultants Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 303 N Clyde Morris Blvd, Daytona Beach, FL 32114 Phone: 636-333-4500 |