Provider Demographics
NPI:1295915932
Name:OSCEOLA INTERNAL MEDICINE INC
Entity type:Organization
Organization Name:OSCEOLA INTERNAL MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ESTEBAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:JANOLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-348-8813
Mailing Address - Street 1:203 WESTMORELAND CIR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-5463
Mailing Address - Country:US
Mailing Address - Phone:407-348-8813
Mailing Address - Fax:407-348-4486
Practice Address - Street 1:203 WESTMORELAND CIR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744
Practice Address - Country:US
Practice Address - Phone:407-348-8813
Practice Address - Fax:407-348-4486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL38377OtherMEDICARE GROUP NO.
FLCK5659OtherRAILROAD MEDICARE
FL38377OtherBCBS GROUP NO