Healthcare Provider Details

I. General information

NPI: 1982920757
Provider Name (Legal Business Name): JOHN L MEISENHEIMER MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2010
Last Update Date: 04/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 SANDLAKE COMMONS BLVD SUITE 105
ORLANDO FL
32819-8050
US

IV. Provider business mailing address

7300 SANDLAKE COMMONS BLVD SUITE 105
ORLANDO FL
32819-8050
US

V. Phone/Fax

Practice location:
  • Phone: 407-352-2444
  • Fax: 407-363-2869
Mailing address:
  • Phone: 407-352-2444
  • Fax: 407-363-2869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberME0049727
License Number StateFL

VIII. Authorized Official

Name: DR. JOHN L MEISENHEIMER
Title or Position: OWNER
Credential: MD
Phone: 407-352-2444