Organization
ORLANDO DERMATOLOGY CLINIC LLC
Active
Organization
ORLANDO DERMATOLOGY CLINIC LLC
Active
Other names
Care Dermatology and Skin Cancer Centers
Organization subpart
No
Provider details
NPI number
Authorized official
TAREK S SHAATH MD (OWNER)
(785) 760-6740
Entity
Organization
Contact information
Practice address
2970 LOOPDALE LANE, KISSIMMEE, FL 34741
(352) 218-3211
Mailing address
1040 LAKE SUMTER LNDG, THE VILLAGES, FL 32162-2697
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
207NS0135X
Procedural Dermatology Physician
—
—
332900000X
Non-Pharmacy Dispensing Site
—
—
Other
Enumeration date
02/04/2021
Last updated
07/14/2021
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