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General NPI Number Information
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NPI Number | 1003847401
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Entity Type | Organization
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Legal Business Name | METRO ORTHOPEDIC SPECIALISTS PL
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 01/24/2009
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Provider Practice Location Address
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Address Line | 3956 TOWN CENTER BLVD PMB 462
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City | ORLANDO
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State | FL
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Zip | 32837-6103
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Country | US
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Telephone | 407-297-0397
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Fax | 407-292-9217
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Provider Business Mailing Address
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Address Line | 3956 TOWN CENTER BLVD PMB 462
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City | ORLANDO
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State | FL
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Zip | 32837-6103
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Country | US
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Telephone | 407-297-0397
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Fax | 407-292-9217
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | PETER GODLESKI
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Credential |
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Telephone | 407-297-0397
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | ME0053893
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License Number State | FL
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