NPIMap

Organization Active NPI

Florida Infectious Disease Group PA

  • Specialist
  • Orlando, FL
National Provider Identifier
1467590463
Registry record updated Jan 2, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
FLORIDA INFECTIOUS DISEASE GROUP PA
Practice address
1012 Lucerne Ter
Orlando, FL 32806-1015
Phone
(407) 423-1039
Fax
(407) 425-2347
NPI assigned
Feb 2, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Carmelo M Licitra, MDNPI 1659347342
Title
Owner
Phone
(407) 423-1039

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

1012 Lucerne Ter
Orlando, FL 32806-1015

Mailing address

PO Box 568766
Orlando, FL 32856-8766
Phone (407) 423-1039

National Provider Directory

National Provider Directory

Locations

1012 Lucerne Ter
Orlando, FL 32806
Phone (321) 841-7750

500 Delaney Ave
Ste 303
Orlando, FL 32801

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199232000000",
    "number": "1467590463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 568766",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328568766",
            "telephone_number": "407-423-1039",
            "fax_number": "407-425-2347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1012 LUCERNE TER",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328061015",
            "telephone_number": "407-423-1039",
            "fax_number": "407-425-2347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA INFECTIOUS DISEASE GROUP PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-02",
        "last_updated": "2008-01-02",
        "status": "A",
        "authorized_official_last_name": "LICITRA",
        "authorized_official_first_name": "CARMELO",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "407-423-1039",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.