Organization
FLORIDA INFECTIOUS DISEASE GROUP PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARMELO M LICITRA MD (OWNER)
(407) 423-1039
Entity
Organization
Contact information
Practice address
1012 LUCERNE TER, ORLANDO, FL 32806-1015
(407) 423-1039
(407) 425-2347
Mailing address
PO BOX 568766, ORLANDO, FL 32856-8766
(407) 423-1039
(407) 425-2347
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
02/02/2007
Last updated
01/02/2008
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