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General NPI Number Information
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NPI Number | 1619039765
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Entity Type | Organization
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Legal Business Name | WESTSIDE MEDICAL CLINIC PA
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 10/25/2007
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Provider Practice Location Address
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Address Line | 5084 W COLONIAL DR
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City | ORLANDO
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State | FL
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Zip | 32808-7666
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Country | US
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Telephone | 407-822-4739
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Fax | 407-822-4789
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Provider Business Mailing Address
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Address Line | 5084 W COLONIAL DR
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City | ORLANDO
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State | FL
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Zip | 32808-7666
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Country | US
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Telephone | 407-822-4739
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROMAN MOSAI
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Credential | M.D.
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Telephone | 407-822-4739
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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 | ME40999
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME40999
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | ME40999
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License Number State | FL
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