Provider Demographics
NPI:1316577638
Name:METRO ORTHOPEDIC SPECIALISTS, LLC
Entity Type:Organization
Organization Name:METRO ORTHOPEDIC SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EMPLOYEE
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:GODLESKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-517-7330
Mailing Address - Street 1:859 COLDWATER CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-1653
Mailing Address - Country:US
Mailing Address - Phone:850-517-7330
Mailing Address - Fax:844-511-6930
Practice Address - Street 1:7300 SAND LAKE CMN STE 312
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8050
Practice Address - Country:US
Practice Address - Phone:850-517-7330
Practice Address - Fax:844-511-6930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-26
Last Update Date:2020-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty