MEDICARE: ORLANDO PORTAL 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
1	207R00000X	Internal Medicine Physician	ME 100005	FL

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	:	1366626111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ORLANDO PORTAL M.D.

Provider Business Mailing Address
First Line	:	219 FLAMINGO DR PMB 3695
Second Line	:
City	:	APOLLO BEACH
State	:	FL
Zip	:	33572-7000
Country	:	US
Telephone Number	:	813-374-8883
Fax Number	:	813-443-8361

Provider Business Practice Location Address
First Line	:	13150 VAIL RIDGE DR
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33579-7187
Country	:	US
Telephone Number	:	813-374-8883
Fax Number	:	813-443-8361

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

Provider Enumeration Date	:	12/27/2007
Last Update Date	:	03/06/2026

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Directions to “ ORLANDO PORTAL M.D.” Practice Location

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