MEDICARE: FLORIDA CANCER SPECIALISTS & RESEARCH INSTITUTE, 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	207RH0000X	Hematology (Internal Medicine) Physician
2	207RX0202X	Medical Oncology 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	:	1154618718
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA CANCER SPECIALISTS & RESEARCH INSTITUTE, LLC

Provider Business Mailing Address
First Line	:	PO BOX 102222
Second Line	:	ATTN: CREDENTIALING DEPARTMENT
City	:	ATLANTA
State	:	GA
Zip	:	30368-2222
Country	:	US
Telephone Number	:	239-274-8200
Fax Number	:	239-278-3350

Provider Business Practice Location Address
First Line	:	750 ORIENTA AVE
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-5621
Country	:	US
Telephone Number	:	407-553-7710
Fax Number	:	866-445-1466

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHAEL DIAZ
Credential	:
Telephone Number	:	239-274-8200

Provider Enumeration Date	:	07/05/2011
Last Update Date	:	08/23/2023

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