Provider Demographics
NPI:1366415978
Name:ORLANDO DIABETES AND ENDOCRINE SPECIALISTS
Entity type:Organization
Organization Name:ORLANDO DIABETES AND ENDOCRINE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AND COLLECTIONS COORIDINATO
Authorized Official - Prefix:
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:L
Authorized Official - Last Name:CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:407-293-2150
Mailing Address - Street 1:6150 METROWEST BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-3289
Mailing Address - Country:US
Mailing Address - Phone:407-293-2150
Mailing Address - Fax:407-293-4540
Practice Address - Street 1:6150 METROWEST BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-3290
Practice Address - Country:US
Practice Address - Phone:407-293-2150
Practice Address - Fax:407-293-4540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-13
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4317Medicare ID - Type Unspecified