MEDICARE: PHYSICIANS MEDICAL AND INJURY GROUP EAST ORLANDO

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	111N00000X	Chiropractor	CH10928	FL
2	204D00000X	Neuromusculoskeletal Medicine & OMM Physician	OS9286	FL
3	261QP2300X	Primary Care Clinic/Center	OS9286	FL

General Provider Information

NPI Number	:	1447790597
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIANS MEDICAL AND INJURY GROUP EAST ORLANDO

Provider Business Mailing Address
First Line	:	7163 UNIVERSITY BLVD
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-6724
Country	:	US
Telephone Number	:	321-441-4944
Fax Number	:	407-636-8749

Provider Business Practice Location Address
First Line	:	7163 UNIVERSITY BLVD
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-6724
Country	:	US
Telephone Number	:	321-441-4944
Fax Number	:	407-636-8749

Authorized Official
Title or Position	:	OWNER
Name	:	DR. WILLIAM FREDERICK VON BARGEN JR.
Credential	:	D.O.
Telephone Number	:	407-450-6991

Provider Enumeration Date	:	03/07/2017
Last Update Date	:	03/07/2017

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Directions to “PHYSICIANS MEDICAL AND INJURY GROUP EAST ORLANDO ” Practice Location

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