Healthcare Provider Details

I. General information

NPI: 1174989958
Provider Name (Legal Business Name): GARY D SLADEK M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2016
Last Update Date: 01/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N ORANGE AVE STE 538
ORLANDO FL
32804-4603
US

IV. Provider business mailing address

2501 N ORANGE AVE STE 538
ORLANDO FL
32804-4603
US

V. Phone/Fax

Practice location:
  • Phone: 407-894-8696
  • Fax: 407-894-4196
Mailing address:
  • Phone: 407-894-8696
  • Fax: 407-894-4196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberME33060
License Number StateFL

VIII. Authorized Official

Name: GARY DEAN SLADEK
Title or Position: OWNER
Credential: M.D.
Phone: 407-894-8696