Provider Demographics
NPI:1407408883
Name:MPP INFUSION CENTER OF KISSIMMEE, LLC
Entity Type:Organization
Organization Name:MPP INFUSION CENTER OF KISSIMMEE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATION OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:ROTTURA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-323-8987
Mailing Address - Street 1:1726 COLE BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3262
Mailing Address - Country:US
Mailing Address - Phone:720-465-5030
Mailing Address - Fax:
Practice Address - Street 1:607 OAK COMMONS BLVD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4213
Practice Address - Country:US
Practice Address - Phone:561-323-8987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-15
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty