Basic Information
| Provider Information | |||||||||
| NPI: | 1285795641 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRAL FLORIDA INTERNAL MEDICINE ASSOCIATES, P.L. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4725 US HIGHWAY 98 S | ||||||||
| Address2: | |||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338124334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8636469663 | ||||||||
| FaxNumber: | 8636469664 | ||||||||
| Practice Location | |||||||||
| Address1: | 4725 US HIGHWAY 98 S | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338124254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8636469663 | ||||||||
| FaxNumber: | 8636469664 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2006 | ||||||||
| LastUpdateDate: | 05/10/2016 | ||||||||
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| AuthorizedOfficialLastName: | SETTEMBRINO | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHAIRMAN | ||||||||
| AuthorizedOfficialTelephone: | 8636469663 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME67759 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1285795641 | 01 | FL | NPI | OTHER | 28191 | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER | 379364800 | 05 | FL | MEDICAID |