Provider Demographics
NPI:1184711442
Name:CENTRAL FLORIDA PEDIATRICS INTENSIVE CARE SPEC
Entity type:Organization
Organization Name:CENTRAL FLORIDA PEDIATRICS INTENSIVE CARE SPEC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUDAPO
Authorized Official - Middle Name:F
Authorized Official - Last Name:SOREMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-894-8768
Mailing Address - Street 1:1349 BALLENTYNE PL
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-6870
Mailing Address - Country:US
Mailing Address - Phone:407-894-8768
Mailing Address - Fax:407-894-6872
Practice Address - Street 1:844 N THORNTON AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-4003
Practice Address - Country:US
Practice Address - Phone:407-894-8768
Practice Address - Fax:407-894-6872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME738892080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL42266Medicare ID - Type Unspecified
FLH54673Medicare UPIN