Provider Demographics
NPI:1508205600
Name:FELIX R MARICHAL MD PA
Entity Type:Organization
Organization Name:FELIX R MARICHAL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:R
Authorized Official - Last Name:MARICHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-802-4655
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC10641208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH80561Medicare UPIN