Healthcare Provider Details

I. General information

NPI: 1265520100
Provider Name (Legal Business Name): MITCHELL MACHADO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7975 LAKE UNDERHILL RD STE 220B
ORLANDO FL
32822
US

IV. Provider business mailing address

7975 LAKE UNDERHILL RD STE 220B
ORLANDO FL
32822-8202
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-6772
  • Fax: 407-303-6775
Mailing address:
  • Phone: 407-303-6772
  • Fax: 407-303-6775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number0101243437
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberME127066
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: