| Ellenton Family Practice Direct Pllc | |
|
907 25th Dr E Ellenton FL 34222-2053 | |
| (941) 321-8299 | |
| Not Available |
| Full Name | Ellenton Family Practice Direct Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 907 25th Dr E, Ellenton, Florida |
| Authorized Official Name and Position | David Allan Hervig (OFFICE MANAGE AND PARTNER) |
| Authorized Official Contact | 9417305326 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ellenton Family Practice Direct Pllc 907 25th Dr E Ellenton FL 34222-2053 Ph: (941) 417-7386 | Ellenton Family Practice Direct Pllc 907 25th Dr E Ellenton FL 34222-2053 Ph: (941) 321-8299 |
| NPI Number | 1124471503 |
|---|---|
| Provider Enumeration Date | 07/20/2016 |
| Last Update Date | 03/07/2023 |
| Medicare PECOS PAC ID | 1052679768 |
|---|---|
| Medicare Enrollment ID | O20171228002269 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124471503 | NPI | - | NPPES |
| OS12316 | Other | FL | LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | PA9102767 (Florida) | Primary |
| Provider Name | Raphael Kulawik |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114238250 PECOS PAC ID: 9830336635 Enrollment ID: I20141222000249 |
| Provider Name | Romain Onteniente |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1821460080 PECOS PAC ID: 2961771902 Enrollment ID: I20170706001207 |
| Provider Name | Stephanie Marie Arreola |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194359554 PECOS PAC ID: 9638562762 Enrollment ID: I20220211001555 |
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