Healthcare Provider Details

I. General information

NPI: 1770842783
Provider Name (Legal Business Name): ELIE RAZZOUK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2012
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N ORANGE AVE STE 235
ORLANDO FL
32804-4659
US

IV. Provider business mailing address

2501 N ORANGE AVE STE 235
ORLANDO FL
32804-4659
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-7270
  • Fax: 407-303-2553
Mailing address:
  • Phone: 407-303-7270
  • Fax: 407-303-2553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberT7706
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME149984
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: