Healthcare Provider Details

I. General information

NPI: 1760871735
Provider Name (Legal Business Name): MEDICAL VEIN CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2015
Last Update Date: 01/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 KUHL AVE STE 103
ORLANDO FL
32806-2004
US

IV. Provider business mailing address

1802 KUHL AVE STE 103
ORLANDO FL
32806-2004
US

V. Phone/Fax

Practice location:
  • Phone: 407-839-0096
  • Fax: 407-839-0096
Mailing address:
  • Phone: 407-839-0096
  • Fax: 407-839-0096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberOS0005776
License Number StateFL

VIII. Authorized Official

Name: DR. FRANCEE A BRODY
Title or Position: OWNER/PHYSICIAN
Credential: D.O.
Phone: 407-839-0096