Provider Demographics
NPI:1649228834
Name:ORLANDO DERMATOLOGY, INC.
Entity Type:Organization
Organization Name:ORLANDO DERMATOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FAROOQ
Authorized Official - Middle Name:
Authorized Official - Last Name:LATEEF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-351-1888
Mailing Address - Street 1:8601 VISTA POINT CV
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32836-6306
Mailing Address - Country:US
Mailing Address - Phone:407-226-9863
Mailing Address - Fax:
Practice Address - Street 1:6000 TURKEY LAKE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819
Practice Address - Country:US
Practice Address - Phone:407-351-1888
Practice Address - Fax:407-226-9804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75932174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF95408Medicare UPIN
FL43906YMedicare ID - Type Unspecified