=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215226196
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTELESO PROCESS INNOVATION, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2011
-----------------------------------------------------
Last Update Date | 03/31/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7713 HORSE FERRY RD
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32835-5964
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-403-6776
-----------------------------------------------------
Fax | 321-710-7236
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7713 HORSE FERRY RD
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32835-5964
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-403-6776
-----------------------------------------------------
Fax | 321-710-7236
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MR. EHTISHAM KHALID KHAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 407-403-6776
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 247100000X
-----------------------------------------------------
Taxonomy Name | Radiologic Technologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------