Provider Demographics
NPI:1326080581
Name:MARICHAL, FELIX R (MD)
Entity Type:Individual
Prefix:
First Name:FELIX
Middle Name:R
Last Name:MARICHAL
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 1:11602 LAKE UNDERHILL RD
Mailing Address - Street 2:SUITE 115 & 116
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-4458
Mailing Address - Country:US
Mailing Address - Phone:407-802-4655
Mailing Address - Fax:407-802-4721
Practice Address - Street 1:11602 LAKE UNDERHILL RD
Practice Address - Street 2:SUITE 115 & 116
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-4458
Practice Address - Country:US
Practice Address - Phone:407-802-4655
Practice Address - Fax:407-802-4721
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90689208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH80561Medicare UPIN
FLE1801Medicare ID - Type Unspecified