MEDICARE: DR. AMAPOLA DUMLAO WHITESIDE MD

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	207R00000X	Internal Medicine Physician	ME116181	FL
2	207RN0300X	Nephrology Physician	ME116181	FL

General Provider Information

NPI Number	:	1760657688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMAPOLA DUMLAO WHITESIDE MD

Provider Business Mailing Address
First Line	:	3885 OAKWATER CIR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32806-6257
Country	:	US
Telephone Number	:	407-851-6226
Fax Number	:	407-438-0507

Provider Business Practice Location Address
First Line	:	221 SW STONEGATE TER
Second Line	:	105
City	:	LAKE CITY
State	:	FL
Zip	:	32024-3463
Country	:	US
Telephone Number	:	386-752-6107
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2008
Last Update Date	:	06/09/2017

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