MEDICARE: CENTER FOR FAMILY PRACTICE & SPORTS MEDICINE 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	207Q00000X	Family Medicine Physician	OS 4999	FL

General Provider Information

NPI Number	:	1558319871
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR FAMILY PRACTICE & SPORTS MEDICINE P.A.

Provider Business Mailing Address
First Line	:	720 OAK COMMONS BLVD
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-4100
Country	:	US
Telephone Number	:	407-933-2522
Fax Number	:	407-932-0215

Provider Business Practice Location Address
First Line	:	720 OAK COMMONS BLVD
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-4100
Country	:	US
Telephone Number	:	407-933-8036
Fax Number	:	407-932-0215

Authorized Official
Title or Position	:	CEO
Name	:	JOEL MARC WEINBERGER
Credential	:	D.O.
Telephone Number	:	407-933-2522

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	11/25/2009

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