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General NPI Number Information
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NPI Number | 1003796871
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Entity Type | Organization
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Legal Business Name | FAMILY MEDICAL GROUP ORLANDO LLC
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Dates
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Enumeration Date | 09/03/2025
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 7824 LAKE UNDERHILL RD STE I
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City | ORLANDO
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State | FL
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Zip | 32822-8201
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Country | US
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Telephone | 407-601-1210
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Fax |
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Provider Business Mailing Address
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Address Line | 12391 SW 130TH ST
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City | MIAMI
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State | FL
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Zip | 33186-6208
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OPERATIONS
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Name | ILEANA COLLADO
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Credential |
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Telephone | 786-971-8016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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