Provider Demographics
NPI:1780911925
Name:CENTRAL FLORIDA INJURY SOUTHWEST, INC
Entity type:Organization
Organization Name:CENTRAL FLORIDA INJURY SOUTHWEST, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:JEROLD
Authorized Official - Middle Name:J
Authorized Official - Last Name:FADEM
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:407-578-2351
Mailing Address - Street 1:882 S KIRKMAN RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-2652
Mailing Address - Country:US
Mailing Address - Phone:407-578-2350
Mailing Address - Fax:407-264-8300
Practice Address - Street 1:882 S KIRKMAN RD STE 101
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-2652
Practice Address - Country:US
Practice Address - Phone:407-578-2350
Practice Address - Fax:407-264-8300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-09
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL204D00000X, 207R00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty