Provider Demographics
NPI:1346651650
Name:ORLANDO PORTAL MD INC
Entity Type:Organization
Organization Name:ORLANDO PORTAL MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ORLANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-374-8883
Mailing Address - Street 1:PO BOX 3695
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-1010
Mailing Address - Country:US
Mailing Address - Phone:813-374-8883
Mailing Address - Fax:813-443-8361
Practice Address - Street 1:13150 VAIL RIDGE DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-7187
Practice Address - Country:US
Practice Address - Phone:813-374-8883
Practice Address - Fax:813-443-8361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-08
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100005207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty