| Medical Village Healthcare Group | |
|
201 Hilda St Second Floor Suite 21 Kissimmee FL 34741-2320 | |
| (407) 944-9777 | |
| (407) 888-3310 |
| Full Name | Medical Village Healthcare Group |
|---|---|
| Speciality | Pediatrics |
| Location | 201 Hilda St, Kissimmee, Florida |
| Authorized Official Name and Position | Khalid Manzur (PRESIDENT) |
| Authorized Official Contact | 4079449777 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Medical Village Healthcare Group 1462 W Oak Ridge Rd Orlando FL 32809-3905 Ph: (407) 944-9777 | Medical Village Healthcare Group 201 Hilda St Second Floor Suite 21 Kissimmee FL 34741-2320 Ph: (407) 944-9777 |
| NPI Number | 1487621694 |
|---|---|
| Provider Enumeration Date | 03/07/2006 |
| Last Update Date | 03/29/2021 |
| Medicare PECOS PAC ID | 2163525825 |
|---|---|
| Medicare Enrollment ID | O20070317000085 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487621694 | NPI | - | NPPES |
| A61366 | Other | FL | INDIVIDUAL PROVIDER UPIN |
| 62935Z | Other | FL | INDIVIDUAL PROVIDER PTAN |
| AC082Z | Other | FL | INDIVIDUAL PROVIDER PTAN |
| G14896 | Other | FL | INDIVIDUAL PROVIDER UPIN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 208000000X | Pediatrics | (* (Not Available)) | Primary |
| Provider Name | Khalid Manzur |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1447223193 PECOS PAC ID: 5193823128 Enrollment ID: I20070614000189 |
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