Provider Demographics
NPI:1710026471
Name:ORESTE INFANTE MD PA
Entity Type:Organization
Organization Name:ORESTE INFANTE MD PA
Other - Org Name:INFANTE MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:DAIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:INFANTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-873-1725
Mailing Address - Street 1:2110 W DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6512
Mailing Address - Country:US
Mailing Address - Phone:813-873-1725
Mailing Address - Fax:813-873-2924
Practice Address - Street 1:2110 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6512
Practice Address - Country:US
Practice Address - Phone:813-873-1725
Practice Address - Fax:813-873-2924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL51298207Q00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty