MEDICARE: CENTRAL FLORIDA INJURY EAST, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	ME 8351	FL
2	207R00000X	Internal Medicine Physician	ME 75343	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1023141819	OTHER	FL	NPI

General Provider Information

NPI Number	:	1023141819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL FLORIDA INJURY EAST, INC

Provider Business Mailing Address
First Line	:	5555 E MICHIGAN ST
Second Line	:	SUITE 102
City	:	ORLANDO
State	:	FL
Zip	:	32822-2700
Country	:	US
Telephone Number	:	407-275-9334
Fax Number	:	407-275-9395

Provider Business Practice Location Address
First Line	:	5555 E MICHIGAN ST
Second Line	:	SUITE 102
City	:	ORLANDO
State	:	FL
Zip	:	32822-2700
Country	:	US
Telephone Number	:	407-275-9334
Fax Number	:	407-275-9395

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. JEROLD J FADEM JR.
Credential	:	M.D.
Telephone Number	:	407-275-9334

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	12/06/2016

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