Provider Demographics
NPI:1851949432
Name:SLAGOSKI, KEVIN J (PA-C)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:J
Last Name:SLAGOSKI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 N ORANGE AVE STE 540
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4674
Mailing Address - Country:US
Mailing Address - Phone:407-303-3692
Mailing Address - Fax:407-303-3634
Practice Address - Street 1:2501 N ORANGE AVE STE 540
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4674
Practice Address - Country:US
Practice Address - Phone:407-303-3692
Practice Address - Fax:407-303-3634
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9112542363A00000X
FL9115242208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant