Provider Demographics
NPI:1275119299
Name:REDONDO ESCUDERO, OSMAICKEL (MD)
Entity Type:Individual
Prefix:
First Name:OSMAICKEL
Middle Name:
Last Name:REDONDO ESCUDERO
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 1:7050 ULMERTON RD
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-5003
Mailing Address - Country:US
Mailing Address - Phone:727-777-4540
Mailing Address - Fax:727-248-0432
Practice Address - Street 1:7050 ULMERTON RD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-5003
Practice Address - Country:US
Practice Address - Phone:727-777-4540
Practice Address - Fax:727-248-0432
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-21
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME166103207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine