Provider Demographics
NPI:1841268778
Name:GARBER, MITCHELL K (DO)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:K
Last Name:GARBER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2582 GREENWILLOW DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-7551
Mailing Address - Country:US
Mailing Address - Phone:321-287-0367
Mailing Address - Fax:407-658-1596
Practice Address - Street 1:11550 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-2100
Practice Address - Country:US
Practice Address - Phone:407-282-2044
Practice Address - Fax:407-658-1596
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS4118207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE16458Medicare UPIN
FL38907Medicare ID - Type Unspecified