Provider Demographics
NPI:1013076298
Name:CANCER INSTITUTE OF FLORIDA PA
Entity Type:Organization
Organization Name:CANCER INSTITUTE OF FLORIDA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:TYO-GROOTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-215-7794
Mailing Address - Street 1:894 E ALTAMONTE DR
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-5002
Mailing Address - Country:US
Mailing Address - Phone:407-215-7794
Mailing Address - Fax:407-215-7799
Practice Address - Street 1:894 E ALTAMONTE DR
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-5002
Practice Address - Country:US
Practice Address - Phone:407-215-7794
Practice Address - Fax:407-215-7799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL72793Medicare PIN