Basic Information
| Provider Information | |||||||||
| NPI: | 1346229101 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INFECTIOUS DISEASE OF CENTRAL FL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22 WEST LAKE BEAUTY DR. | ||||||||
| Address2: | STE 104 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328062945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4072461946 | ||||||||
| FaxNumber: | 4072461411 | ||||||||
| Practice Location | |||||||||
| Address1: | 22 LAKE BEAUTY DR | ||||||||
| Address2: | STE 104 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328062037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4072461946 | ||||||||
| FaxNumber: | 4072461411 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2006 | ||||||||
| LastUpdateDate: | 09/07/2010 | ||||||||
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| AuthorizedOfficialLastName: | ZIGLER | ||||||||
| AuthorizedOfficialFirstName: | HEATHER | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4072461946 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | ME40632 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 040887500 | 05 | FL | MEDICAID |