Organization
ADVANCE MEDICAL SPECIALTY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HEMWATTIE S JAIMANGAL DO (PRESIDENT)
(352) 633-9858
Entity
Organization
Contact information
Practice address
8550 NE 138TH LN STE 500, LADY LAKE, FL 32159-6804
(352) 633-9858
(352) 633-9870
Mailing address
18981 US HIGHWAY 441 STE 121, MOUNT DORA, FL 32757-6735
(352) 201-5949
(352) 729-2287
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
OS10278
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
021679600
—
FL
Enumeration date
07/10/2017
Last updated
06/05/2024
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