| Legacy Family Medicine Llc | |
|
11602 Lake Underhill Rd Ste 119 Orlando FL 32825-4460 | |
| (407) 781-1000 | |
| (407) 781-1001 |
| Full Name | Legacy Family Medicine Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 11602 Lake Underhill Rd Ste 119, Orlando, Florida |
| Authorized Official Name and Position | Philip T Hardy (PHYSICIAN/OWNER) |
| Authorized Official Contact | 4077811000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Legacy Family Medicine Llc 11602 Lake Underhill Rd Suite 119 Orlando FL 32825-4458 Ph: (407) 781-1000 | Legacy Family Medicine Llc 11602 Lake Underhill Rd Ste 119 Orlando FL 32825-4460 Ph: (407) 781-1000 |
| NPI Number | 1477878940 |
|---|---|
| Provider Enumeration Date | 03/29/2010 |
| Last Update Date | 01/20/2015 |
| Medicare PECOS PAC ID | 0345378451 |
|---|---|
| Medicare Enrollment ID | O20100511000923 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477878940 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Philip T Hardy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548247869 PECOS PAC ID: 1658315767 Enrollment ID: I20050620000027 |
| Provider Name | Melika Abdulwhab |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538662515 PECOS PAC ID: 8527322023 Enrollment ID: I20180509002468 |
| Provider Name | Shatera N Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073277406 PECOS PAC ID: 2860877156 Enrollment ID: I20220922003094 |
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