Provider Demographics
NPI:1841754371
Name:DR ROBERT UDELL DO LLC
Entity Type:Organization
Organization Name:DR ROBERT UDELL DO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:UDELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:321-338-7885
Mailing Address - Street 1:255 N SYKES CREEK PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-3518
Mailing Address - Country:US
Mailing Address - Phone:321-338-7885
Mailing Address - Fax:
Practice Address - Street 1:255 N SYKES CREEK PKWY STE 101
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-3518
Practice Address - Country:US
Practice Address - Phone:321-338-7885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty