Healthcare Provider Details

I. General information

NPI: 1336302421
Provider Name (Legal Business Name): JOSE FELIX BICHARA SUDAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 11/13/2020
Certification Date: 11/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4882 QUALITY TRL
ORLANDO FL
32829-8203
US

IV. Provider business mailing address

PO BOX 677879
ORLANDO FL
32867-7879
US

V. Phone/Fax

Practice location:
  • Phone: 407-440-3004
  • Fax: 407-429-3899
Mailing address:
  • Phone: 407-440-3004
  • Fax: 407-429-3899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME109349
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME109349
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: