Healthcare Provider Details

I. General information

NPI: 1659830883
Provider Name (Legal Business Name): KAREL SHAMYL ORTIZ-TAVAREZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E ROLLINS ST
ORLANDO FL
32803-1248
US

IV. Provider business mailing address

2501 N ORANGE AVE STE 446
ORLANDO FL
32804-4644
US

V. Phone/Fax

Practice location:
  • Phone: 407-975-0412
  • Fax:
Mailing address:
  • Phone: 407-975-0412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME157939
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME157939
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: