Healthcare Provider Details

I. General information

NPI: 1457590721
Provider Name (Legal Business Name): CENTRAL FLORIDA INFECTIOUS DISEASES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2009
Last Update Date: 02/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 AVENUE F SW
WINTER HAVEN FL
33880-3432
US

IV. Provider business mailing address

11321 LAUREL BROOK CT
RIVERVIEW FL
33569-2023
US

V. Phone/Fax

Practice location:
  • Phone: 863-293-1121
  • Fax: 863-291-6028
Mailing address:
  • Phone: 254-718-8329
  • Fax: 863-583-8555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME99435
License Number StateFL

VIII. Authorized Official

Name: DR. LINDSAY MATHEW JOHN
Title or Position: MANAGING MEMBER
Credential: M.D
Phone: 254-718-8329