Organization
MID FLORIDA INTERNAL MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SANJAY PRAKASH MUTTREJA MD (PRESIDENT)
(321) 229-5479
Entity
Organization
Contact information
Practice address
11036 BRIDGE HOUSE DR, WINDERMERE, FL 34786-5404
(321) 229-5479
(407) 876-8286
Mailing address
P.O. BOX 929, WINDERMERE, FL 34786-0929
(321) 229-5479
(407) 876-8286
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
73769
FL
208M00000X
Hospitalist Physician
Primary
ME0073769
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
263823100
—
FL
Enumeration date
04/06/2007
Last updated
04/05/2013
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