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General NPI Number Information
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NPI Number | 1154319689
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Entity Type | Individual
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Provider Name | WALTER MACEDO JR. MD
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Gender | Male
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Dates
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Enumeration Date | 10/10/2005
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Last Update Date | 05/08/2024
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Provider Practice Location Address
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Address Line | 1600 LAKELAND HILLS BLVD
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City | LAKELAND
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State | FL
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Zip | 33805
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Country | US
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Telephone | 863-680-7000
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Fax | 866-264-8519
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Provider Business Mailing Address
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Address Line | 124 CELEBRATION BLVD
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City | CELEBRATION
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State | FL
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Zip | 34747-5010
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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 |
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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 | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | ME80024
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License Number State | FL
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