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General NPI Number Information
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NPI Number | 1447498688
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Entity Type | Organization
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Legal Business Name | WISECARE OF FLORIDA, P.A.
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Dates
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Enumeration Date | 01/27/2009
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Last Update Date | 03/26/2015
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Provider Practice Location Address
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Address Line | 3501 13TH ST
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City | SAINT CLOUD
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State | FL
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Zip | 34769-4054
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Country | US
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Telephone | 407-891-6463
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Fax |
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Provider Business Mailing Address
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Address Line | 3501 13TH ST
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City | SAINT CLOUD
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State | FL
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Zip | 34769-4054
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Country | US
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Telephone | 407-891-6463
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Fax | 407-891-0213
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | AHMED AIDOO
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Credential | MD, MPH
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Telephone | 407-891-6463
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME 96098
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | ME96098
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License Number State | FL
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