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NPI Code Detail

MEDICARE: DR. ELIAM MANUEL FUENTES TIRADO M.D.

MEDICARE: DR. ELIAM MANUEL FUENTES TIRADO M.D.
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
1208100000XPhysical Medicine & Rehabilitation PhysicianME114560FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1528297264
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ELIAM MANUEL FUENTES TIRADO M.D.
Provider Business Mailing Address
First Line : 13136 WOODFORD ST
Second Line :
City : ORLANDO
State : FL
Zip : 32832
Country : US
Telephone Number : 787-955-0232
Fax Number :
Provider Business Practice Location Address
First Line : 831 S STATE ROAD 434
Second Line :
City : ALTAMONTE SPRINGS
State : FL
Zip : 32714-3502
Country : US
Telephone Number : 407-256-3456
Fax Number : 407-730-2176
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/02/2009
Last Update Date : 05/26/2015

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