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NPI Code Detail

MEDICARE: MISAEL TOLLEN IRIZARRY M.D.

MEDICARE: MISAEL TOLLEN IRIZARRY 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
1207Q00000XFamily Medicine PhysicianME167584FL

General Provider Information

NPI Number : 1174978233
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISAEL TOLLEN IRIZARRY M.D.
Provider Business Mailing Address
First Line : 2724 N HIAWASSEE RD STE 100
Second Line :
City : ORLANDO
State : FL
Zip : 32818-3003
Country : US
Telephone Number : 407-906-0082
Fax Number : 407-604-2606
Provider Business Practice Location Address
First Line : 2724 N HIAWASSEE RD STE 100
Second Line :
City : ORLANDO
State : FL
Zip : 32818-3003
Country : US
Telephone Number : 407-906-0082
Fax Number : 407-604-2606
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2016
Last Update Date : 04/05/2024

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