MEDICARE: GREATER ORLANDO SURGICAL GROUP, LLC

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	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1073461976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREATER ORLANDO SURGICAL GROUP, LLC

Provider Business Mailing Address
First Line	:	4104 MILLENIA BLVD STE 111
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32839-6422
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4104 MILLENIA BLVD STE 111
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32839-6422
Country	:	US
Telephone Number	:	407-753-7000
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	NANCY KASTNER
Credential	:
Telephone Number	:	407-256-0933

Provider Enumeration Date	:	03/18/2026
Last Update Date	:	03/18/2026

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