Basic Information
| Provider Information | |||||||||
| NPI: | 1508097759 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GEORGE R IKELER, M.D P.A. | ||||||||
| LastName: | |||||||||
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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: | 3527354044 | ||||||||
| FaxNumber: | 3527352536 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2009 | ||||||||
| LastUpdateDate: | 02/05/2013 | ||||||||
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| AuthorizedOfficialLastName: | IKELER | ||||||||
| AuthorizedOfficialFirstName: | GEORGE | ||||||||
| AuthorizedOfficialMiddleName: | RAYMOND | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3527354044 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | ME12314 | FL | Y | Ambulatory Health Care Facilities | Clinic/Center |
ID Information
| ID | Type | State | Issuer | Description | 043349700 | 05 | FL | MEDICAID |