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General NPI Number Information
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NPI Number | 1205189503
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Entity Type | Organization
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Legal Business Name | THE INSTITUTE OF DIABETIC NEUROPATHY
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Dates
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Enumeration Date | 10/24/2012
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Last Update Date | 10/24/2012
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Provider Practice Location Address
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Address Line | 4937 E COLONIAL DR
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City | ORLANDO
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State | FL
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Zip | 32803-4309
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Country | US
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Telephone | 404-406-4621
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 570573
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City | ORLANDO
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State | FL
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Zip | 32857-0573
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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 | ADMINISTRATOR
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Name | MATTHEW BUITRAGO
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Credential |
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Telephone | 954-559-6062
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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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