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General NPI Number Information
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NPI Number | 1013137694
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Entity Type | Individual
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Provider Name | MICHAEL SULLIVAN WIEDERHOLD M.D., M.P.H., M.S.
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Gender | Male
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 04/28/2016
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Provider Practice Location Address
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Address Line | 900 HOPE WAY
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32714-1502
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Country | US
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Telephone | 407-357-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 900 HOPE WAY
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32714-1502
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Country | US
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Telephone | 407-357-1000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME0111708
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | E-6152
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License Number State | AR
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