Organization
TAMPA BAY ORTHOPAEDIC DESIGNS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. OLAF MICKLE HOLM SR. LPO, CO, BOCPO (OWNER/PRESIDENT)
(813) 224-0525
Entity
Organization
Contact information
Practice address
812 W MARTIN LUTHER KING BLVD, STE 100, TAMPA, FL 33603-3338
(813) 224-0525
(813) 224-0622
Mailing address
812 W MARTIN LUTHER KING BLVD, STE 100, TAMPA, FL 33603-3338
(813) 224-0525
(813) 224-0622
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
POR124
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005843900
—
FL
Enumeration date
08/31/2005
Last updated
12/18/2019
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