| Path Medical - East | |
|
10967 Lake Underhill Rd Ste 120 Orlando FL 32825-4454 | |
| (407) 367-3040 | |
| (407) 367-3043 |
| Full Name | Path Medical - East |
|---|---|
| Speciality | Clinic/center |
| Location | 10967 Lake Underhill Rd Ste 120, Orlando, Florida |
| Authorized Official Name and Position | Neil Bonnardel (DIRECTOR OF MEDICAL SERVICES) |
| Authorized Official Contact | 7542182164 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Path Medical - East 2304 W Oakland Park Blvd Oakland Park FL 33311-1422 Ph: (754) 218-2164 | Path Medical - East 10967 Lake Underhill Rd Ste 120 Orlando FL 32825-4454 Ph: (407) 367-3040 |
| NPI Number | 1467998252 |
|---|---|
| Provider Enumeration Date | 01/17/2017 |
| Last Update Date | 11/06/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467998252 | NPI | - | NPPES |
| HCC8601 | Other | FL | STATE LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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