Provider Demographics
NPI:1003847401
Name:METRO ORTHOPEDIC SPECIALISTS PL
Entity Type:Organization
Organization Name:METRO ORTHOPEDIC SPECIALISTS PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:GODLESKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-297-0397
Mailing Address - Street 1:3956 TOWN CENTER BLVD
Mailing Address - Street 2:PMB 462
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-6103
Mailing Address - Country:US
Mailing Address - Phone:407-297-0397
Mailing Address - Fax:407-292-9217
Practice Address - Street 1:3956 TOWN CENTER BLVD
Practice Address - Street 2:PMB 462
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-6103
Practice Address - Country:US
Practice Address - Phone:407-297-0397
Practice Address - Fax:407-292-9217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2009-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0053893207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty