MEDICARE: ORLANDO DIABETES AND ENDOCRINE SPECIALISTS

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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician

General Provider Information

NPI Number	:	1366415978
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORLANDO DIABETES AND ENDOCRINE SPECIALISTS

Provider Business Mailing Address
First Line	:	6150 METROWEST BLVD
Second Line	:	SUITE 105
City	:	ORLANDO
State	:	FL
Zip	:	32835-3289
Country	:	US
Telephone Number	:	407-293-2150
Fax Number	:	407-293-4540

Provider Business Practice Location Address
First Line	:	6150 METROWEST BLVD
Second Line	:	SUITE 105
City	:	ORLANDO
State	:	FL
Zip	:	32835-3290
Country	:	US
Telephone Number	:	407-293-2150
Fax Number	:	407-293-4540

Authorized Official
Title or Position	:	BILLING AND COLLECTIONS COORIDINATO
Name	:	KERRI L CONNELL
Credential	:	CPC
Telephone Number	:	407-293-2150

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	04/16/2008

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