MEDICARE: MRS. MARIA GONZALES TURK LMT

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	MA 0018453	FL

General Provider Information

NPI Number	:	1740372218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIA GONZALES TURK LMT

Provider Business Mailing Address
First Line	:	611 BROADWAY AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-4501
Country	:	US
Telephone Number	:	407-841-7693
Fax Number	:

Provider Business Practice Location Address
First Line	:	5542 LAKE HOWELL RD
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-1036
Country	:	US
Telephone Number	:	407-673-5528
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	07/08/2007

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