| Optum | |
|
5130 Sunforest Dr Ste 300 Tampa FL 33634-6327 | |
| (727) 824-0780 | |
| (813) 514-8891 |
| Full Name | Optum |
|---|---|
| Speciality | General Practice |
| Location | 5130 Sunforest Dr Ste 300, Tampa, Florida |
| Authorized Official Name and Position | John G. Liethen (SECRETARY) |
| Authorized Official Contact | 9522056262 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Optum 5130 Sunforest Dr Ste 300 Tampa FL 33634-6327 Ph: (727) 824-0780 | Optum 5130 Sunforest Dr Ste 300 Tampa FL 33634-6327 Ph: (727) 824-0780 |
| NPI Number | 1437434735 |
|---|---|
| Provider Enumeration Date | 10/18/2011 |
| Last Update Date | 11/24/2021 |
| Medicare PECOS PAC ID | 3678732294 |
|---|---|
| Medicare Enrollment ID | O20120316000439 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437434735 | NPI | - | NPPES |
| 004371300 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Mike Perl |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1215980438 PECOS PAC ID: 3779557061 Enrollment ID: I20040823001015 |
| Provider Name | Jyothi Krishnamurthy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861597734 PECOS PAC ID: 9436253150 Enrollment ID: I20070404000557 |
| Provider Name | Israel E Penate |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1427073329 PECOS PAC ID: 0547364283 Enrollment ID: I20070405000098 |
| Provider Name | Amaury Gomez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1831106277 PECOS PAC ID: 8123124922 Enrollment ID: I20070510000187 |
| Provider Name | Yelena Zotova Bedard |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609007210 PECOS PAC ID: 4688824238 Enrollment ID: I20121017000492 |
| Provider Name | Sergey Petrov |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1497752901 PECOS PAC ID: 8123093440 Enrollment ID: I20180914002311 |
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