Organization
MEDICAL VILLAGE HEALTHCARE GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KHALID MANZUR MD (PRESIDENT)
(407) 944-9777
Entity
Organization
Contact information
Practice address
201 HILDA ST, SECOND FLOOR SUITE 21, KISSIMMEE, FL 34741-2320
(407) 944-9777
(407) 888-3310
Mailing address
1462 W OAK RIDGE RD, ORLANDO, FL 32809-3905
(407) 944-9777
(407) 944-9796
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
62935Z
INDIVIDUAL PROVIDER PTAN
FL
01
—
A61366
INDIVIDUAL PROVIDER UPIN
FL
01
—
AC082Z
INDIVIDUAL PROVIDER PTAN
FL
01
—
G14896
INDIVIDUAL PROVIDER UPIN
FL
Enumeration date
03/07/2006
Last updated
03/29/2021
Update your record
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