MEDICARE: ENDOCRINOLOGY OF CENTRAL FLORIDA 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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician		FL

General Provider Information

NPI Number	:	1730185307
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENDOCRINOLOGY OF CENTRAL FLORIDA PA

Provider Business Mailing Address
First Line	:	141 VICTORIA COMMONS BLVD
Second Line	:
City	:	DELAND
State	:	FL
Zip	:	32724-7700
Country	:	US
Telephone Number	:	386-427-4544
Fax Number	:	386-427-8688

Provider Business Practice Location Address
First Line	:	141 VICTORIA COMMONS BLVD
Second Line	:
City	:	DELAND
State	:	FL
Zip	:	32724-7700
Country	:	US
Telephone Number	:	386-427-4544
Fax Number	:	386-427-8688

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LEE NATHANIEL METCHICK
Credential	:	MD
Telephone Number	:	386-427-4544

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	04/24/2024

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1346244191 — UNIVERSITY EAST REHABILITATION CENTER, LLC
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