Individual
DR. WADIH S. MACKSOUD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1717 S ORANGE AVE, #103, ORLANDO, FL 32806-2944
(407) 236-0404
(407) 236-0402
Mailing address
1285 ORANGE AVE, WINTER PARK, FL 32789-4949
(407) 647-2287
(407) 643-1300
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
ME0056028
FL
207XS0106X
Orthopaedic Hand Surgery Physician
Primary
ME0056028
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
061726100
—
FL
01
—
09393
BC/BS
FL
01
—
200030018
RAILROAD
FL
Enumeration date
07/15/2005
Last updated
05/15/2015
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