Provider Demographics
NPI:1548463003
Name:KOLA, MOIN H (MD)
Entity type:Individual
Prefix:DR
First Name:MOIN
Middle Name:H
Last Name:KOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:100 N DEAN RD
Mailing Address - Street 2:STE 101
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-3710
Mailing Address - Country:US
Mailing Address - Phone:407-384-7388
Mailing Address - Fax:407-384-7391
Practice Address - Street 1:2415 N ORANGE AVE STE 200
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-5505
Practice Address - Country:US
Practice Address - Phone:407-303-1812
Practice Address - Fax:407-303-1815
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME101271207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001997900Medicaid
FL001997900Medicaid
FLCS671XMedicare PIN