MEDICARE: MITCHELL LEWIS SUPLER MD

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	207T00000X	Neurological Surgery Physician	ME 64445	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	46892	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1114990553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITCHELL LEWIS SUPLER MD

Provider Business Mailing Address
First Line	:	10000 W COLONIAL DR STE 284
Second Line	:
City	:	OCOEE
State	:	FL
Zip	:	34761-3432
Country	:	US
Telephone Number	:	321-841-1570
Fax Number	:	321-841-8185

Provider Business Practice Location Address
First Line	:	10000 W COLONIAL DR STE 284
Second Line	:
City	:	OCOEE
State	:	FL
Zip	:	34761-3432
Country	:	US
Telephone Number	:	321-841-1570
Fax Number	:	321-841-8185

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	09/08/2023

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