Healthcare Provider Details

I. General information

NPI: 1609755065
Provider Name (Legal Business Name): UPPERLINE HEALTHCARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2025
Last Update Date: 08/29/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 KEVSTIN DRIVE
KISSIMMEE FL
34744
US

IV. Provider business mailing address

1111 KEVSTIN DRIVE
KISSIMMEE FL
34744
US

V. Phone/Fax

Practice location:
  • Phone: 407-846-1234
  • Fax:
Mailing address:
  • Phone: 407-846-1234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL KING
Title or Position: DPM
Credential:
Phone: 407-219-5402