Healthcare Provider Details

I. General information

NPI: 1316681653
Provider Name (Legal Business Name): MICHAEL JIANXIAO WU DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2022
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10489 N FLORIDA AVE
CITRUS SPRINGS FL
34434-3268
US

IV. Provider business mailing address

1600 LAKELAND HILLS BLVD
LAKELAND FL
33805-3065
US

V. Phone/Fax

Practice location:
  • Phone: 352-489-2486
  • Fax: 352-489-5786
Mailing address:
  • Phone: 863-680-7000
  • Fax: 866-264-8519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS21082
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: