MEDICARE: DR. FELIX BRADLEY WIDLACKI DO

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	2084P0800X	Psychiatry Physician	125-053116	IL
2	2084P0800X	Psychiatry Physician	OS11223	FL

General Provider Information

NPI Number	:	1356507008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FELIX BRADLEY WIDLACKI DO

Provider Business Mailing Address
First Line	:	6601 MEMORIAL HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-4501
Country	:	US
Telephone Number	:	813-981-9005
Fax Number	:

Provider Business Practice Location Address
First Line	:	6601 MEMORIAL HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-4501
Country	:	US
Telephone Number	:	813-981-9005
Fax Number	:

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

Provider Enumeration Date	:	08/01/2008
Last Update Date	:	02/08/2022

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