Provider Demographics
NPI:1376020743
Name:GREATER ORLANDO ORTHOPEDIC GROUP
Entity Type:Organization
Organization Name:GREATER ORLANDO ORTHOPEDIC GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:V
Authorized Official - Last Name:HUDANICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-977-4130
Mailing Address - Street 1:773 STIRLING CENTER PL
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-4856
Mailing Address - Country:US
Mailing Address - Phone:407-977-4130
Mailing Address - Fax:
Practice Address - Street 1:773 STIRLING CENTER PL
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-4856
Practice Address - Country:US
Practice Address - Phone:407-977-4130
Practice Address - Fax:407-977-4139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-27
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Multi-Specialty