Provider Demographics
NPI:1871159400
Name:ADVANCE PREVENTIVE MEDICINE URGENT CARE, LLC
Entity type:Organization
Organization Name:ADVANCE PREVENTIVE MEDICINE URGENT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAIED
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEMIRANEI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-845-8623
Mailing Address - Street 1:1400 E ROBINSON ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-2120
Mailing Address - Country:US
Mailing Address - Phone:407-845-8623
Mailing Address - Fax:407-845-8667
Practice Address - Street 1:1400 E ROBINSON ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-2120
Practice Address - Country:US
Practice Address - Phone:407-845-8623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-20
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty