Healthcare Provider Details

I. General information

NPI: 1912990359
Provider Name (Legal Business Name): MICHAEL C FLATLEY D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 07/03/2020
Certification Date: 07/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2014 S ORANGE AVE STE 100
ORLANDO FL
32806-3069
US

IV. Provider business mailing address

3165 MCCRORY PL STE 174
ORLANDO FL
32803-3727
US

V. Phone/Fax

Practice location:
  • Phone: 407-423-1234
  • Fax: 407-517-1040
Mailing address:
  • Phone: 407-219-5402
  • Fax: 407-517-1040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO3961
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: