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NPI Code Detail

MEDICARE: DR. DARIUSZ GRZEGORZ MYDLARZ M.D.

MEDICARE: DR. DARIUSZ GRZEGORZ MYDLARZ M.D.
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
1208D00000XGeneral Practice Physician0101235066VA
2208D00000XGeneral Practice PhysicianME139388FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1ME139388OTHERFLMEDICAL LICENSE

General Provider Information

NPI Number : 1063494631
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DARIUSZ GRZEGORZ MYDLARZ M.D.
Provider Business Mailing Address
First Line : 6416 OLD WINTER GARDEN RD
Second Line :
City : ORLANDO
State : FL
Zip : 32835-1348
Country : US
Telephone Number : 407-751-7288
Fax Number : 407-770-0661
Provider Business Practice Location Address
First Line : 6336 W COLONIAL DR
Second Line :
City : ORLANDO
State : FL
Zip : 32818-7812
Country : US
Telephone Number : 407-219-5200
Fax Number : 321-281-8700
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/18/2005
Last Update Date : 03/05/2019

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