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General NPI Number Information
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NPI Number | 1962904201
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Entity Type | Organization
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Legal Business Name | DR. GAMPOLO, LLC
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Dates
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Enumeration Date | 03/02/2018
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 1320 S ORLANDO AVE STE 3
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City | WINTER PARK
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State | FL
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Zip | 32789-5556
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Country | US
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Telephone | 407-504-0177
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Fax | 407-530-0779
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Provider Business Mailing Address
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Address Line | 1320 S ORLANDO AVE STE 3
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City | WINTER PARK
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State | FL
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Zip | 32789-5556
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Country | US
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Telephone | 407-504-0177
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Fax | 407-530-0779
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Authorized Official
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Title or Position | OWNER/MGR
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Name | DR. MICHAEL ANTHONY GAMPOLO II
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Credential | DC
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Telephone | 407-504-0117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | CH11616
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License Number State | FL
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