MEDICARE: FLORIDA UROLOGY 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	208800000X	Urology Physician		FL

Other Identifiers

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

General Provider Information

NPI Number	:	1619974854
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA UROLOGY PA

Provider Business Mailing Address
First Line	:	2400 N ORANGE BLOSSOM TRL
Second Line	:	SUITE 210
City	:	KISSIMMEE
State	:	FL
Zip	:	34744-2306
Country	:	US
Telephone Number	:	407-933-2500
Fax Number	:	407-933-0586

Provider Business Practice Location Address
First Line	:	2400 N ORANGE BLOSSOM TRL
Second Line	:	SUITE 210
City	:	KISSIMMEE
State	:	FL
Zip	:	34744-2306
Country	:	US
Telephone Number	:	407-933-2500
Fax Number	:	407-933-2925

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	SHARON G COLOGERO
Credential	:
Telephone Number	:	407-933-2500

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	07/21/2022

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Directions to “FLORIDA UROLOGY PA ” Practice Location

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