Provider Demographics
NPI:1417917253
Name:UNIVERSITY DIAGNOSTIC INSTITUTE WINTER PARK PLLC
Entity Type:Organization
Organization Name:UNIVERSITY DIAGNOSTIC INSTITUTE WINTER PARK PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-975-3315
Mailing Address - Street 1:111 N LAKEMONT AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3213
Mailing Address - Country:US
Mailing Address - Phone:407-975-3315
Mailing Address - Fax:407-691-0316
Practice Address - Street 1:111 N LAKEMONT AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3213
Practice Address - Country:US
Practice Address - Phone:407-975-3315
Practice Address - Fax:407-691-0316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263170900Medicaid