Organization
FLORIDA INSTITUTE OF DERMATOLOGY LLC
Active
Organization
FLORIDA INSTITUTE OF DERMATOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL WAUDO WANGIA MD (PHYSICIAN/OWNER)
(352) 594-1942
Entity
Organization
Contact information
Practice address
1503 BUENOS AIRES BLVD STE 130, THE VILLAGES, FL 32159-6826
(407) 395-3770
(407) 395-3779
Mailing address
1503 BUENOS AIRES BLVD STE 130, THE VILLAGES, FL 32159-6826
(407) 395-3770
(407) 395-3779
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ME112379
MEDICAL LICENSE
FL
Enumeration date
06/02/2021
Last updated
06/02/2021
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