Organization
OPTUMCARE SOUTH FLORIDA, LLC
Active
Other names
Optum
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN G. LIETHEN (SECRETARY)
(952) 205-6262
Entity
Organization
Contact information
Practice address
5130 SUNFOREST DR STE 300, TAMPA, FL 33634-6327
(727) 824-0780
(813) 514-8891
Mailing address
5130 SUNFOREST DR STE 300, TAMPA, FL 33634-6327
(727) 824-0780
(813) 514-8891
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004371300
—
FL
Enumeration date
10/18/2011
Last updated
11/24/2021
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