MEDICARE: VASCULAR SPECIALISTS OF CENTRAL FLORIDA

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	2086S0129X	Vascular Surgery Physician	ME48437	FL

General Provider Information

NPI Number	:	1942323555
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VASCULAR SPECIALISTS OF CENTRAL FLORIDA

Provider Business Mailing Address
First Line	:	1120 CITRUS TOWER BLVD
Second Line	:	SUITE 120
City	:	CLERMONT
State	:	FL
Zip	:	34711-1909
Country	:	US
Telephone Number	:	352-241-7585
Fax Number	:	352-241-7595

Provider Business Practice Location Address
First Line	:	1120 CITRUS TOWER BLVD
Second Line	:	SUITE 120
City	:	CLERMONT
State	:	FL
Zip	:	34711-1909
Country	:	US
Telephone Number	:	352-241-7585
Fax Number	:	352-241-7595

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL J COHEN
Credential	:	MD
Telephone Number	:	352-241-7585

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	08/22/2020

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