Unknown Individual – General Practice Physician, NPI 1164608956
General Practice Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Unknown Individual
2648 W STATE ROAD 434
SUITE C
LONGWOOD, FL 327794440
Phone: (407) 788-7778
Fax: (407) 788-7770
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
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Educational use only—not medical, billing, or legal advice.
No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
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No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 32779)
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