MAITLAND FAMILY PRACTICE NPI 1558464669

NPI Information

  • NPI: 1558464669
  • Provider Name: MAITLAND FAMILY PRACTICE
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • CLIA Number: 10D0897942
  • Address: 402 LAKE HOWELL RD
    MAITLAND, FL
    ZIP 32751
  • Phone: (407) 628-4312

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NPI Details

MAITLAND FAMILY PRACTICE is a family medicine in Maitland, FL. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. MAITLAND FAMILY PRACTICE NPI is 1558464669. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

402 LAKE HOWELL RD
MAITLAND, FL
ZIP 32751-907
Phone: (407) 628-4312
Fax: (407) 628-1845

The provider's authorized official is Eddie C Waldheim .
The authorized official title is President and has the following contact phone number (407) 628-4312.

The CLIA number assigned to this NPI record is 10D0897942 - other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/6/2006 and was last updated on 9/23/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily MedicineYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
197117MEDICARE PINFLORIDA
2265582900MEDICAIDFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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