Healthcare Provider Details

I. General information

NPI: 1225013717
Provider Name (Legal Business Name): GARY DEAN SLADEK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N ORANGE AVE 538
ORLANDO FL
32804-4603
US

IV. Provider business mailing address

2501 N ORANGE AVE 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:
Title or Position:
Credential:
Phone: