Healthcare Provider Details

I. General information

NPI: 1679101562
Provider Name (Legal Business Name): MICHAEL PATRICK PENFOLD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2020
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N ORANGE AVE STE 310
ORLANDO FL
32804-4642
US

IV. Provider business mailing address

2501 N ORANGE AVE STE 310
ORLANDO FL
32804-4642
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-2001
  • Fax: 407-303-2450
Mailing address:
  • Phone: 407-303-2001
  • Fax: 407-303-2450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number30881
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberME180106
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: