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2600 Lake Lucien Dr Ste 112 Maitland FL 32751-7233 | |
| (321) 207-9029 | |
| (844) 410-7960 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 2600 Lake Lucien Dr Ste 112, Maitland, Florida |
| Authorized Official Name and Position | Rajiv N Patel (CEO) |
| Authorized Official Contact | 2488246600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
500 Kirts Blvd Ste 100 Troy MI 48084-4135 Ph: (248) 434-6169 | 2600 Lake Lucien Dr Ste 112 Maitland FL 32751-7233 Ph: (321) 207-9029 |
| NPI Number | 1811537491 |
|---|---|
| Provider Enumeration Date | 01/10/2020 |
| Last Update Date | 07/19/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811537491 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 208D00000X | General Practice | (* (Not Available)) | Secondary |
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