Healthcare Provider Details

I. General information

NPI: 1104805951
Provider Name (Legal Business Name): CENTRAL FLORIDA PULMONARY GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 03/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 E. RIDGEWOOD ST.
ORLANDO FL
32803
US

IV. Provider business mailing address

1115 E. RIDGEWOOD ST.
ORLANDO FL
32803
US

V. Phone/Fax

Practice location:
  • Phone: 407-841-1100
  • Fax: 407-650-0262
Mailing address:
  • Phone: 407-841-1100
  • Fax: 407-650-0262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JESSICA L. KLEIN
Title or Position: ASSISTANT ADMINISTRATOR
Credential:
Phone: 407-841-1100