MEDICARE: ORLANDO DERMATOLOGY, INC.

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	174400000X	Specialist	ME75932	FL
2	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1649228834
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORLANDO DERMATOLOGY, INC.

Provider Business Mailing Address
First Line	:	2810 W SAINT ISABEL ST STE 201
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6375
Country	:	US
Telephone Number	:	813-890-8004
Fax Number	:	813-290-9691

Provider Business Practice Location Address
First Line	:	6001 VINELAND RD STE 116
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-7829
Country	:	US
Telephone Number	:	407-351-1888
Fax Number	:	407-226-9804

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. FAROOQ LATEEF
Credential	:	M.D.
Telephone Number	:	407-351-1888

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	03/25/2026

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Practice Location Address:

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1891894325 — DR. JOSE F GUTIERREZ MD
Practice Location Address:

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Directions to “ORLANDO DERMATOLOGY, INC. ” Practice Location

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