Healthcare Provider Details

I. General information

NPI: 1225004963
Provider Name (Legal Business Name): CHARLES S HUANG D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 10/12/2021
Certification Date: 10/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 S FLORIDA AVE STE 3
LAKELAND FL
33813-3310
US

IV. Provider business mailing address

6700 S FLORIDA AVE STE 3
LAKELAND FL
33813-3310
US

V. Phone/Fax

Practice location:
  • Phone: 863-940-4750
  • Fax: 888-755-4350
Mailing address:
  • Phone: 863-940-4750
  • Fax: 888-755-4350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberOS0007183
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberOS0007183
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: