Organization
FLORIDA ENT ADULT & PEDIATRIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OMAR FADHLI MD (PHYSICIAN ENT SPECIALIST)
(407) 343-9006
Entity
Organization
Contact information
Practice address
1162 CYPRESS GLEN CIR, KISSIMMEE, FL 34741-7560
(407) 343-9006
(407) 343-0999
Mailing address
1162 CYPRESS GLEN CIR, KISSIMMEE, FL 34741-7560
(407) 343-9006
(407) 343-0999
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
ME0077191
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AB304
MEDICARE PTAN
FL
Enumeration date
03/29/2006
Last updated
11/09/2021
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