| Mid Florida Primary Care Pa | |
|
401 North Blvd W Leesburg FL 34748-5044 | |
| (352) 728-4242 | |
| (352) 728-4868 |
| Full Name | Mid Florida Primary Care Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 401 North Blvd W, Leesburg, Florida |
| Authorized Official Name and Position | Ravi P Gupta (PRESIDENT) |
| Authorized Official Contact | 3527284242 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mid Florida Primary Care Pa 401 North Blvd W Leesburg FL 34748-5044 Ph: (352) 728-4242 | Mid Florida Primary Care Pa 401 North Blvd W Leesburg FL 34748-5044 Ph: (352) 728-4242 |
| NPI Number | 1598827479 |
|---|---|
| Provider Enumeration Date | 12/15/2006 |
| Last Update Date | 05/02/2013 |
| Medicare PECOS PAC ID | 7416049044 |
|---|---|
| Medicare Enrollment ID | O20070827000712 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598827479 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | ME71724 (Florida) | Primary |
| Provider Name | Stephen Mark Ross |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1194700823 PECOS PAC ID: 9739077264 Enrollment ID: I20040308000324 |
| Provider Name | Ravi Gupta |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1922077338 PECOS PAC ID: 9133211766 Enrollment ID: I20100721000917 |
| Provider Name | Deanna Lynn Koenen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538591888 PECOS PAC ID: 7012150972 Enrollment ID: I20140130000282 |
| Provider Name | Louis Bernadin Claudel Bois |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508127002 PECOS PAC ID: 2264738152 Enrollment ID: I20160302000869 |
| Provider Name | Yun Mi Sung |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003390014 PECOS PAC ID: 1951648344 Enrollment ID: I20190123001932 |
| Provider Name | Dharma Deekshita Lakshman Rao |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144785882 PECOS PAC ID: 8325371891 Enrollment ID: I20190617000174 |
| Provider Name | Jewell Marie Conway |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184227779 PECOS PAC ID: 6507257078 Enrollment ID: I20211217001303 |
| Provider Name | Shannan L Veit |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619613437 PECOS PAC ID: 2567842412 Enrollment ID: I20220708002465 |
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