Organization
ADVANCED MEDICAL CLINIC P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ISHAN A GUNAWARDENE MD (PRESIDENT & CEO)
(561) 434-1935
Entity
Organization
Contact information
Practice address
3347 STATE RD7, SUITE 206, WELLINGTON, FL 33449-8095
(561) 434-1935
(561) 434-3169
Mailing address
3347 STATE ROAD 7, SUITE 206, WELLINGTON, FL 33449-8095
(561) 434-1935
(561) 434-3169
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME81674
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
33244
BCBS GROUP
FL
01
—
DF6667
RR MEDICARE
FL
Enumeration date
09/20/2006
Last updated
07/02/2012
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