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General NPI Number Information
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NPI Number | 1588086953
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Entity Type | Organization
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Legal Business Name | MEDI WINTER PARK LLC
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Dates
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Enumeration Date | 01/20/2014
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Last Update Date | 06/02/2016
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Provider Practice Location Address
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Address Line | 1234 W FAIRBANKS AVE
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City | WINTER PARK
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State | FL
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Zip | 32789-4890
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Country | US
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Telephone | 407-673-5555
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Fax |
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Provider Business Mailing Address
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Address Line | 1234 W FAIRBANKS AVE
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City | WINTER PARK
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State | FL
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Zip | 32789-4890
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Country | US
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Telephone | 407-673-5555
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHRISTOPHER TRACY
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Credential |
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Telephone | 407-256-5119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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