MEDICARE: ROBERTS ORTHOPAEDIC CLINIC PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	ME0041010	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	47628	OTHER	FL	PTAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003064841
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERTS ORTHOPAEDIC CLINIC PA

Provider Business Mailing Address
First Line	:	453 N KIRKMAN RD STE 201
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32811-1109
Country	:	US
Telephone Number	:	407-292-8992
Fax Number	:	407-292-6114

Provider Business Practice Location Address
First Line	:	453 N KIRKMAN RD STE 201
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32811-1109
Country	:	US
Telephone Number	:	407-292-8992
Fax Number	:	407-292-6114

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. SONIA SHAFFEEULLAH
Credential	:
Telephone Number	:	407-292-8992

Provider Enumeration Date	:	09/05/2008
Last Update Date	:	09/05/2008

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