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NPI Code Detail

MEDICARE: MS. DESIREE DISMUKE

MEDICARE: MS. DESIREE DISMUKE
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
1247200000XOther Technician

General Provider Information

NPI Number : 1417495821
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DESIREE DISMUKE
Provider Business Mailing Address
First Line : 1883 POMEGRANATE CT
Second Line :
City : OCOEE
State : FL
Zip : 34761-7699
Country : US
Telephone Number : 407-600-7424
Fax Number :
Provider Business Practice Location Address
First Line : 151 W CHURCH AVE
Second Line :
City : LONGWOOD
State : FL
Zip : 32750-4105
Country : US
Telephone Number : 407-342-4220
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2017
Last Update Date : 06/06/2019

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