MEDICARE: PULMONARY INSTITUTE, P.A.

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	207RP1001X	Pulmonary Disease Physician	ME93134	FL

General Provider Information

NPI Number	:	1427294974
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PULMONARY INSTITUTE, P.A.

Provider Business Mailing Address
First Line	:	8803 FUTURES DR STE 7
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-9076
Country	:	US
Telephone Number	:	407-219-5936
Fax Number	:	407-480-3455

Provider Business Practice Location Address
First Line	:	8803 FUTURES DR STE 7
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-9076
Country	:	US
Telephone Number	:	407-219-5936
Fax Number	:	407-480-3455

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARISELLY MEDINA-IRIZARRY
Credential	:	MD
Telephone Number	:	407-405-0722

Provider Enumeration Date	:	01/05/2009
Last Update Date	:	12/03/2010

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