Provider Demographics
NPI:1760415491
Name:MAINSTREET MEDICAL CENTER
Entity Type:Organization
Organization Name:MAINSTREET MEDICAL CENTER
Other - Org Name:MAINSTREET PHYSICIANS
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ARLENE
Authorized Official - Middle Name:M
Authorized Official - Last Name:PALAZZOLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-370-4881
Mailing Address - Street 1:1587 S LYONS CT
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765
Mailing Address - Country:US
Mailing Address - Phone:407-365-1424
Mailing Address - Fax:
Practice Address - Street 1:8723 INTERNATIONAL DR
Practice Address - Street 2:SUITE 115
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-9337
Practice Address - Country:US
Practice Address - Phone:407-370-4881
Practice Address - Fax:407-370-4867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1279552363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD85766Medicare UPIN