# MEDEK PROVIDER NETWORK LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356959779
- **Authorized official:** EUGENE MAHFOOD (DIRECTOR OF OPERATIONS)
- **Authorized official phone:** (954) 892-3940

## Contact information

- **Practice address:** 131 WATERMAN AVE, MOUNT DORA, FL 32757-9541
- **Practice address phone:** (352) 385-1803
- **Mailing address:** 131 WATERMAN AVE, MOUNT DORA, FL 32757-9541
- **Mailing address phone:** (352) 385-1803

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/22/2020
- **Last updated:** 07/06/2021