Organization
UCFAA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY VANDER HEIDEN (DIRECTOR OF SPORTS MEDICINE)
(407) 823-2030
Entity
Organization
Contact information
Practice address
4000 CENTRAL FLORIDA BLVD RM 102, ORLANDO, FL 32816-8005
(407) 823-2030
Mailing address
4000 CENTRAL FLORIDA BLVD, ORLANDO, FL 32816-8005
(708) 228-1243
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
AL 3863
FL
Other
Enumeration date
01/10/2016
Last updated
01/10/2016
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