Provider Demographics
NPI:1558655647
Name:LYMPHEDEMA CLINIC OF ORLANDO, INC
Entity Type:Organization
Organization Name:LYMPHEDEMA CLINIC OF ORLANDO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:M
Authorized Official - Last Name:ESKANDARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-865-6700
Mailing Address - Street 1:2139 W STATE ROAD 434
Mailing Address - Street 2:SUITE #101
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-5019
Mailing Address - Country:US
Mailing Address - Phone:407-865-6700
Mailing Address - Fax:
Practice Address - Street 1:2139 W STATE ROAD 434
Practice Address - Street 2:SUITE #101
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-5019
Practice Address - Country:US
Practice Address - Phone:407-865-6700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-06
Last Update Date:2011-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100524208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY8233YMedicare PIN
FLEV614YMedicare PIN
FLFJ552AMedicare PIN