Healthcare Provider Details

I. General information

NPI: 1326567959
Provider Name (Legal Business Name): MICHAEL LITTLES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2017
Last Update Date: 09/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3160 SOUTHGATE COMMERCE BLVD STE 38D
ORLANDO FL
32806-8549
US

IV. Provider business mailing address

2875 S ORANGE AVE STE 500-1710
ORLANDO FL
32806-5455
US

V. Phone/Fax

Practice location:
  • Phone: 813-598-4699
  • Fax:
Mailing address:
  • Phone: 813-598-4699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberL5000169369
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: