Healthcare Provider Details

I. General information

NPI: 1447498688
Provider Name (Legal Business Name): WISECARE OF FLORIDA, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2009
Last Update Date: 03/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 13TH ST
SAINT CLOUD FL
34769-4054
US

IV. Provider business mailing address

3501 13TH ST
SAINT CLOUD FL
34769-4054
US

V. Phone/Fax

Practice location:
  • Phone: 407-891-6463
  • Fax:
Mailing address:
  • Phone: 407-891-6463
  • Fax: 407-891-0213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME 96098
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberME96098
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateFL

VIII. Authorized Official

Name: AHMED AIDOO
Title or Position: PHYSICIAN/OWNER
Credential: MD, MPH
Phone: 407-891-6463