Organization
OPTUMCARE FLORIDA CI, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN G. LIETHEN (SECRETARY)
(952) 205-6262
Entity
Organization
Contact information
Practice address
2304 ALOMA AVE STE 100, WINTER PARK, FL 32792-3330
(407) 679-9222
Mailing address
10051 5TH ST N STE 200, ST PETERSBURG, FL 33702-2211
(727) 828-2335
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
08/31/2017
Last updated
08/19/2019
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