MEDICARE: MACKENZIE MICHAELS BLACKSTOCK

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1780526087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MACKENZIE MICHAELS BLACKSTOCK

Provider Business Mailing Address
First Line	:	2415 N ORANGE AVE STE 400
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-5505
Country	:	US
Telephone Number	:	407-303-7203
Fax Number	:

Provider Business Practice Location Address
First Line	:	2415 N ORANGE AVE STE 400
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-5505
Country	:	US
Telephone Number	:	407-303-7203
Fax Number	:

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

Provider Enumeration Date	:	04/07/2026
Last Update Date	:	04/07/2026

Similar Medicare Providers

1952571671 — DR. DAVID VARNAGY MD
Practice Location Address:

2415 N ORANGE AVE STE 302
ORLANDO, FL
32804-5505

Practice Phone: 407-303-7250
Practice Fax: 407-303-7255

1942142591 — DR. MAKENNA ROSE BOWMAN MD
Practice Location Address:

2415 N ORANGE AVE STE 400
ORLANDO, FL
32804-5505

Practice Phone: 407-303-7203
Practice Fax:

1962401331 — NIRAV Y. RAVAL MD
Practice Location Address:

2415 N ORANGE AVE , SUITE 600
ORLANDO, FL
32804-5505

Practice Phone: 407-303-2172
Practice Fax: 407-303-0678

1427058932 — EVELINE S. WALLACE ARNP
Practice Location Address:

2415 N ORANGE AVE , SUITE # 700
ORLANDO, FL
32804-5505

Practice Phone: 407-303-7171
Practice Fax: 407-303-7195

1770577504 — DR. MICHAEL ANGELIS MD
Practice Location Address:

2415 N ORANGE AVE , SUITE 700
ORLANDO, FL
32804-5505

Practice Phone: 407-303-2474
Practice Fax: 407-303-0680

1376524553 — DR. JOHN D BUSOWSKI MD
Practice Location Address:

2415 N ORANGE AVE STE 402
ORLANDO, FL
32804-5505

Practice Phone: 407-622-0560
Practice Fax:

Directions to “ MACKENZIE MICHAELS BLACKSTOCK ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.