Provider Demographics
NPI:1124027867
Name:MACKSOUD, WADIH S (MD)
Entity Type:Individual
Prefix:DR
First Name:WADIH
Middle Name:S
Last Name:MACKSOUD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1285 ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4949
Mailing Address - Country:US
Mailing Address - Phone:407-647-2287
Mailing Address - Fax:407-643-1300
Practice Address - Street 1:1717 S ORANGE AVE
Practice Address - Street 2:#103
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2944
Practice Address - Country:US
Practice Address - Phone:407-236-0404
Practice Address - Fax:407-236-0402
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0056028207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL09393OtherBC/BS
FL200030018OtherRAILROAD
FL061726100Medicaid
FL061726100Medicaid
FL09393ZMedicare PIN