| |
1111 Lucerne Ter Orlando FL 32806-1016 | |
(407) 704-3403 | |
(608) 665-4991 |
Full Name | |
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Speciality | Clinic/center - Multi-specialty |
Location | 1111 Lucerne Ter, Orlando, Florida |
Authorized Official Name and Position | Jon Leizman (PRESIDENT) |
Authorized Official Contact | 2164799063 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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5500 Maryland Way Brentwood TN 37027-7048 Ph: () - | 1111 Lucerne Ter Orlando FL 32806-1016 Ph: (407) 704-3403 |
NPI Number | 1770257834 |
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Provider Enumeration Date | 08/03/2021 |
Last Update Date | 08/15/2022 |
Identifier | Type | State | Issuer |
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1770257834 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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