| Pk Cherian Md Llc | |
|
758 N Sun Dr Ste 104 Lake Mary FL 32746-2599 | |
| (407) 333-3303 | |
| Not Available |
| Full Name | Pk Cherian Md Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 758 N Sun Dr Ste 104, Lake Mary, Florida |
| Authorized Official Name and Position | Pothen C Koruth (PHYSICIAN) |
| Authorized Official Contact | 4078109033 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pk Cherian Md Llc 758 N Sun Dr Ste 104 Lake Mary FL 32746-2599 Ph: (407) 333-3303 | Pk Cherian Md Llc 758 N Sun Dr Ste 104 Lake Mary FL 32746-2599 Ph: (407) 333-3303 |
| NPI Number | 1841882669 |
|---|---|
| Provider Enumeration Date | 02/04/2021 |
| Last Update Date | 02/09/2021 |
| Medicare PECOS PAC ID | 0749694875 |
|---|---|
| Medicare Enrollment ID | O20210201000227 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841882669 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Pothen Cherian Koruth |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1093768400 PECOS PAC ID: 0042276065 Enrollment ID: I20041201001091 |
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