Healthcare Provider Details

I. General information

NPI: 1073253084
Provider Name (Legal Business Name): MARIO EMMANUEL LAVELANET MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7727 LAKE UNDERHILL RD
ORLANDO FL
32822-8224
US

IV. Provider business mailing address

1089 PROVIDENCE LN
OVIEDO FL
32765-7065
US

V. Phone/Fax

Practice location:
  • Phone: 407-821-3508
  • Fax:
Mailing address:
  • Phone: 718-795-7746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME173967
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME173967
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: