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General NPI Number Information
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NPI Number | 1891711180
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Entity Type | Organization
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Legal Business Name | ORLANDO INFECTIOUS DISEASE CENTER, P.A,
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 07/08/2013
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Provider Practice Location Address
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Address Line | 4711 CURRY FORD RD SUITE C
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City | ORLANDO
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State | FL
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Zip | 32812-2704
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Country | US
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Telephone | 407-999-5225
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Fax | 407-999-5226
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Provider Business Mailing Address
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Address Line | 4711 CURRY FORD RD SUITE C
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City | ORLANDO
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State | FL
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Zip | 32812-2704
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Country | US
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Telephone | 407-999-5225
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Fax | 407-999-5226
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | JILLIAN PHILLIPS
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Credential |
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Telephone | 407-999-5225
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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 | ME78605
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License Number State | FL
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