MEDICARE: RESTORATIVE RHEUMATOLOGY & ARTHRITIS CLINIC, LLC

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	207RR0500X	Rheumatology Physician

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	:	1447966569
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTORATIVE RHEUMATOLOGY & ARTHRITIS CLINIC, LLC

Provider Business Mailing Address
First Line	:	499 E CENTRAL PKWY STE 205
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-3450
Country	:	US
Telephone Number	:	407-212-7693
Fax Number	:

Provider Business Practice Location Address
First Line	:	499 E CENTRAL PKWY STE 205
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-3450
Country	:	US
Telephone Number	:	407-212-7693
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	LESLIE BENNY
Credential	:	D.O.
Telephone Number	:	407-212-7693

Provider Enumeration Date	:	01/24/2023
Last Update Date	:	02/02/2023

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