Provider Demographics
NPI:1811175516
Name:ENRIQUE UMPIERRE MD PLLC
Entity type:Organization
Organization Name:ENRIQUE UMPIERRE MD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:GERARDO
Authorized Official - Last Name:UMPIERRE-SCHUCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PA
Authorized Official - Phone:407-673-9533
Mailing Address - Street 1:3727 N GOLDENROD RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-8611
Mailing Address - Country:US
Mailing Address - Phone:407-673-9533
Mailing Address - Fax:407-673-1442
Practice Address - Street 1:3727 N GOLDENROD RD
Practice Address - Street 2:SUITE 103
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-8611
Practice Address - Country:US
Practice Address - Phone:407-673-9533
Practice Address - Fax:407-673-1442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81176261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267621400Medicaid
FL267621400Medicaid
FL5244790001Medicare NSC
FLAI272Medicare PIN