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Organization
OLYMPIA MEDICAL GROUP, LLC
Active
Organization
OLYMPIA MEDICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BALA KODE (MANAGING PARTNER)
(863) 547-9200
Entity
Organization
Contact information
Practice address
2306 NORTH BLVD W STE C, DAVENPORT, FL 33837-8976
(863) 547-9200
Mailing address
2306 NORTH BLVD W STE C, DAVENPORT, FL 33837-8976
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
105446600
—
FL
01
—
HCC11921
CLINIC LICENSE
FL
Enumeration date
02/11/2019
Last updated
12/22/2023
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