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General NPI Number Information
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NPI Number | 1124319587
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Entity Type | Organization
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Legal Business Name | ORANGE COUNTY NEUROLOGY CLINIC, LLC
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Dates
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Enumeration Date | 04/20/2011
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Last Update Date | 07/29/2018
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Provider Practice Location Address
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Address Line | 4359 HUNTERS PARK LN
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City | ORLANDO
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State | FL
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Zip | 32837-7614
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Country | US
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Telephone | 407-251-6511
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Fax | 407-251-6513
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Provider Business Mailing Address
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Address Line | 4359 HUNTERS PARK LN
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City | ORLANDO
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State | FL
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Zip | 32837-7614
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Country | US
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Telephone | 407-251-6511
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Fax | 407-251-6513
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | YASSAR CHAKFE
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Credential | MD
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Telephone | 407-251-6511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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