Healthcare Provider Details

I. General information

NPI: 1124111760
Provider Name (Legal Business Name): MICHAEL JOHN HOGAN CPO/LPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 06/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1731 S ORANGE AVE
ORLANDO FL
32806-2935
US

IV. Provider business mailing address

1731 S ORANGE AVE
ORLANDO FL
32806-2935
US

V. Phone/Fax

Practice location:
  • Phone: 407-781-2360
  • Fax: 407-781-2362
Mailing address:
  • Phone: 407-781-2360
  • Fax: 407-781-2362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCPO02315
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberCPO02315
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: