MEDICARE: ORLANDO ALTERNATIVE HEALTH, LLC

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	171100000X	Acupuncturist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1922414077	OTHER	FL	171100000X

General Provider Information

NPI Number	:	1376000851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORLANDO ALTERNATIVE HEALTH, LLC

Provider Business Mailing Address
First Line	:	32 N HYER AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32801-2928
Country	:	US
Telephone Number	:	703-898-7280
Fax Number	:

Provider Business Practice Location Address
First Line	:	1617 HILLCREST ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-4809
Country	:	US
Telephone Number	:	703-898-7280
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. JONATHAN A KUKOR
Credential	:	AP
Telephone Number	:	703-898-7280

Provider Enumeration Date	:	02/21/2019
Last Update Date	:	02/21/2019

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