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Individual

CHAD MICHAEL HIETSCHOLD

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
7975 LAKE UNDERHILL RD, ORLANDO, FL 32822-8202
(407) 303-6830
Mailing address
2501 N ORANGE AVE STE 235, ORLANDO, FL 32804-4659

Taxonomy

Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
OS17435
FL
390200000X
Student in an Organized Health Care Education/Training Program

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1528563137
FL
Enumeration date
03/26/2018
Last updated
05/31/2021
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