Basic Information
| Provider Information | |||||||||
| NPI: | 1013944933 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | IKELER | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | RAYMOND | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31450 CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | SORRENTO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327769594 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527354044 | ||||||||
| FaxNumber: | 3527352536 | ||||||||
| Practice Location | |||||||||
| Address1: | 31450 CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | SORRENTO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327769594 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527354033 | ||||||||
| FaxNumber: | 3527352536 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 05/24/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME12314 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 043349700 | 05 | FL | MEDICAID |