Provider Demographics
NPI:1114062205
Name:WINTER PARK NEONATOLOGY
Entity Type:Organization
Organization Name:WINTER PARK NEONATOLOGY
Other - Org Name:FLORIDA NEONATOLOGY GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:IJAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-876-7631
Mailing Address - Street 1:8980 KILGORE RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32836-5414
Mailing Address - Country:US
Mailing Address - Phone:407-876-7631
Mailing Address - Fax:407-876-8235
Practice Address - Street 1:8980 KILGORE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32836-5414
Practice Address - Country:US
Practice Address - Phone:407-876-7631
Practice Address - Fax:407-876-8235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0059456174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME0059456OtherMEDICAL LICENCE #
FLME0059456OtherMEDICAL LICENCE #
FLE-94935Medicare UPIN