Healthcare Provider Details

I. General information

NPI: 1164884995
Provider Name (Legal Business Name): CHRISTIAN D RESTREPO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 05/25/2022
Certification Date: 05/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3070 DYER BLVD
KISSIMMEE FL
34741-7839
US

IV. Provider business mailing address

3070 DYER BLVD
KISSIMMEE FL
34741-7839
US

V. Phone/Fax

Practice location:
  • Phone: 407-932-7930
  • Fax: 321-203-4653
Mailing address:
  • Phone: 407-932-7930
  • Fax: 321-203-4653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME149039
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberS1498
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: