Healthcare Provider Details

I. General information

NPI: 1164490637
Provider Name (Legal Business Name): CHRISTIAN O ORAEDU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 11/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 SE 18TH AVE STE 3
OCALA FL
34471-8314
US

IV. Provider business mailing address

PO BOX 6195
OCALA FL
34478
US

V. Phone/Fax

Practice location:
  • Phone: 352-690-6000
  • Fax: 352-690-6643
Mailing address:
  • Phone: 352-690-6000
  • Fax: 352-690-6643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME85455
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberME85455
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: