Healthcare Provider Details

I. General information

NPI: 1972718450
Provider Name (Legal Business Name): MESSIEH ORTHOPEDIC CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 08/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 6TH ST SE
WINTER HAVEN FL
33880-4605
US

IV. Provider business mailing address

1601 6TH ST SE
WINTER HAVEN FL
33880-4605
US

V. Phone/Fax

Practice location:
  • Phone: 863-419-9301
  • Fax: 863-419-9304
Mailing address:
  • Phone: 863-419-9301
  • Fax: 863-419-9304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberME54966
License Number StateFL

VIII. Authorized Official

Name: SONIA ROMAN
Title or Position: BILLING CLERK
Credential:
Phone: 863-419-9301