Healthcare Provider Details

I. General information

NPI: 1063705879
Provider Name (Legal Business Name): FREDERICK E SOLIMAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3451 TECHNOLOGICAL AVE STE 15
ORLANDO FL
32817-8353
US

IV. Provider business mailing address

3451 TECHNOLOGICAL AVE STE 15
ORLANDO FL
32817-8353
US

V. Phone/Fax

Practice location:
  • Phone: 407-380-8705
  • Fax: 407-643-2804
Mailing address:
  • Phone: 407-380-8705
  • Fax: 407-643-2804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberOS17222
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: