| Organization Name: | MEDI WINTER PARK LLC |
| NPI Number: | 1588086953 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHRISTOPHER TRACY (PRESIDENT) |
| Mailing Address: | 1234 W Fairbanks Ave Winter Park |
| State: | FL US |
| Postal Code: | 327894890 |
| Phone Number: | 4076735555 |
| Fax Number: | |
| NPI Enumeration Date: | 01/20/2014 |
| NPI Last Update Date: | 06/02/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |