Healthcare Provider Details

I. General information

NPI: 1295239051
Provider Name (Legal Business Name): LOU HAROLD MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 03/23/2020
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1173 BLACKWOOD AVE
OCOEE FL
34761-4518
US

IV. Provider business mailing address

1173 BLACKWOOD AVE
OCOEE FL
34761-4518
US

V. Phone/Fax

Practice location:
  • Phone: 407-839-3700
  • Fax: 407-839-0640
Mailing address:
  • Phone: 407-839-3700
  • Fax: 407-839-0640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberME047257
License Number StateFL

VIII. Authorized Official

Name: LOU HAROLD
Title or Position: PRESIDENT
Credential: MD
Phone: 407-839-3700