| Supreme Medical Group Pllc | |
|
10967 Lake Under Hill Rd Unit 137 Orlando FL 32825-4455 | |
| (407) 930-1030 | |
| (407) 386-7277 |
| Full Name | Supreme Medical Group Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 10967 Lake Under Hill Rd, Orlando, Florida |
| Authorized Official Name and Position | Sheena Mary Jose (MEDICAL DIRECTOR) |
| Authorized Official Contact | 4079301030 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Supreme Medical Group Pllc 10967 Lake Under Hill Road Unit 137 Orlando FL 32825-4455 Ph: (407) 930-1030 | Supreme Medical Group Pllc 10967 Lake Under Hill Rd Unit 137 Orlando FL 32825-4455 Ph: (407) 930-1030 |
| NPI Number | 1073970810 |
|---|---|
| Provider Enumeration Date | 01/25/2016 |
| Last Update Date | 12/23/2020 |
| Medicare PECOS PAC ID | 1557655867 |
|---|---|
| Medicare Enrollment ID | O20160810000106 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073970810 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | ME109765 (Florida) | Primary |
| Provider Name | Sheena M Jose |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1659307759 PECOS PAC ID: 3779510474 Enrollment ID: I20120302000562 |
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