Provider Demographics
NPI:1982920757
Name:JOHN L MEISENHEIMER MD PA
Entity Type:Organization
Organization Name:JOHN L MEISENHEIMER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MEISENHEIMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-352-2444
Mailing Address - Street 1:7300 SANDLAKE COMMONS BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-8050
Mailing Address - Country:US
Mailing Address - Phone:407-352-2444
Mailing Address - Fax:407-363-2869
Practice Address - Street 1:7300 SANDLAKE COMMONS BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8050
Practice Address - Country:US
Practice Address - Phone:407-352-2444
Practice Address - Fax:407-363-2869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0049727207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL04058Medicare PIN