Healthcare Provider Details

I. General information

NPI: 1073193835
Provider Name (Legal Business Name): KEVIN EMMANUEL MORILES DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N ORANGE AVE
ORLANDO FL
32804-4603
US

IV. Provider business mailing address

95 COLLIER RD NW STE 5015
ATLANTA GA
30309-1721
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-7133
  • Fax:
Mailing address:
  • Phone: 404-605-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number95974
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number12667
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: