MEDICARE: ORANGE COUNTY NEUROLOGY CLINIC, 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	2084N0400X	Neurology Physician

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

General Provider Information

NPI Number	:	1124319587
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORANGE COUNTY NEUROLOGY CLINIC, LLC

Provider Business Mailing Address
First Line	:	4359 HUNTERS PARK LN
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32837-7614
Country	:	US
Telephone Number	:	407-251-6511
Fax Number	:	407-251-6513

Provider Business Practice Location Address
First Line	:	4359 HUNTERS PARK LN
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32837-7614
Country	:	US
Telephone Number	:	407-251-6511
Fax Number	:	407-251-6513

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	YASSAR CHAKFE
Credential	:	MD
Telephone Number	:	407-251-6511

Provider Enumeration Date	:	04/20/2011
Last Update Date	:	07/29/2018

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