Healthcare Provider Details

I. General information

NPI: 1588622419
Provider Name (Legal Business Name): LEE M. ZEHNGEBOT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 05/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N ORANGE AVE SUITE 381
ORLANDO FL
32804-4623
US

IV. Provider business mailing address

300 S INTERLACHEN AVE UNIT 403
WINTER PARK FL
32789-4474
US

V. Phone/Fax

Practice location:
  • Phone: 407-898-5452
  • Fax: 407-894-1183
Mailing address:
  • Phone: 407-256-3472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberME0046635
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: