MEDICARE: ORLANDO SLEEP DISORDERS CENTER PA

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	207RS0012X	Sleep Medicine (Internal Medicine) Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CK4550	OTHER	FL	RAILROAD MEDICARE PTAN

General Provider Information

NPI Number	:	1558345546
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORLANDO SLEEP DISORDERS CENTER PA

Provider Business Mailing Address
First Line	:	942 LAKE BALDWIN LN
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32814-6651
Country	:	US
Telephone Number	:	407-898-5201
Fax Number	:	407-898-5233

Provider Business Practice Location Address
First Line	:	942 LAKE BALDWIN LN
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32814-6651
Country	:	US
Telephone Number	:	407-898-5201
Fax Number	:	407-898-5233

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BARRY JOHN DECKER
Credential	:	M.D.
Telephone Number	:	407-898-5201

Provider Enumeration Date	:	12/02/2005
Last Update Date	:	01/26/2010

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