Healthcare Provider Details

I. General information

NPI: 1023141819
Provider Name (Legal Business Name): CENTRAL FLORIDA INJURY EAST, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 12/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 E MICHIGAN ST SUITE 102
ORLANDO FL
32822-2700
US

IV. Provider business mailing address

5555 E MICHIGAN ST SUITE 102
ORLANDO FL
32822-2700
US

V. Phone/Fax

Practice location:
  • Phone: 407-275-9334
  • Fax: 407-275-9395
Mailing address:
  • Phone: 407-275-9334
  • Fax: 407-275-9395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME 75343
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME 8351
License Number StateFL

VIII. Authorized Official

Name: DR. JEROLD J FADEM JR.
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 407-275-9334