Organization
ORLANDO DERMATOLOGY CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAREK S SHAATH (OWNER)
(785) 760-6740
Entity
Organization
Contact information
Practice address
2970 LOOPDALE LN, KISSIMMEE, FL 34741-7658
(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
—
—
Other
Enumeration date
01/28/2021
Last updated
11/03/2022
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