Provider Demographics
NPI:1750825311
Name:ORLANDO CLINIC FOR ASTHMA&RESPIRATORY DISEASE
Entity Type:Organization
Organization Name:ORLANDO CLINIC FOR ASTHMA&RESPIRATORY DISEASE
Other - Org Name:PUTNAM MEDICAL PRACTICE
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE/CLINICAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:H
Authorized Official - Last Name:FEIBELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:386-530-2749
Mailing Address - Street 1:700 ZEAGLER DR
Mailing Address - Street 2:STE 6
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-6806
Mailing Address - Country:US
Mailing Address - Phone:386-530-2749
Mailing Address - Fax:386-530-2735
Practice Address - Street 1:700 ZEAGLER DR
Practice Address - Street 2:STE 6
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-6806
Practice Address - Country:US
Practice Address - Phone:386-530-2749
Practice Address - Fax:386-530-2735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-15
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME38708207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041503000Medicaid
FLD58900Medicare UPIN
FL041503000Medicaid