Provider Demographics
NPI:1083859375
Name:DIPLOMAT ORTHOPAEDIC GROUP PA
Entity Type:Organization
Organization Name:DIPLOMAT ORTHOPAEDIC GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:LANGONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-920-1230
Mailing Address - Street 1:3990 SHERIDAN ST
Mailing Address - Street 2:SUITE 214
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3661
Mailing Address - Country:US
Mailing Address - Phone:954-920-1230
Mailing Address - Fax:
Practice Address - Street 1:3990 SHERIDAN ST
Practice Address - Street 2:SUITE 214
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3661
Practice Address - Country:US
Practice Address - Phone:954-920-1230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-16
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0054640207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME0054640OtherFL MEDICAL LICENSE
FLE55291OtherUPIN
FL10840AMedicare PIN