Organization
PREMIUM MEDICAL CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAFAA ABDEL-AL M.D. (PRESIDENT/OWNER)
(407) 212-3060
Entity
Organization
Contact information
Practice address
12211 REGENCY VILLAGE DR, SUITE 2, ORLANDO, FL 32821-7813
(407) 212-3060
(877) 644-7808
Mailing address
12211 REGENCY VILLAGE DR, SUITE 2, ORLANDO, FL 32821-7813
(407) 212-3060
(877) 644-7808
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME97108
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002150900
—
FL
01
—
1465P
BCBS
FL
Enumeration date
05/06/2010
Last updated
02/01/2012
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