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General NPI Number Information
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NPI Number | 1568903482
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Entity Type | Organization
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Legal Business Name | FLORIDIAN MEDICAL GROUP INC
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Dates
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Enumeration Date | 03/10/2017
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Last Update Date | 07/20/2023
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Provider Practice Location Address
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Address Line | 804 EMMETT ST
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City | KISSIMMEE
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State | FL
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Zip | 34741-5434
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Country | US
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Telephone | 407-449-4559
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Fax | 407-588-8626
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Provider Business Mailing Address
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Address Line | 804 EMMETT ST
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City | KISSIMMEE
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State | FL
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Zip | 34741-5434
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Country | US
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Telephone | 407-449-4559
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Fax |
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Authorized Official
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Title or Position | OFFICE DIRECTOR
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Name | MRS. YINA FRASURE
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Credential |
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Telephone | 407-744-1130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | BTR-09881
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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