Provider Demographics
NPI:1194750893
Name:GODLESKI, PETER (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:GODLESKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 SAND LAKE COMMONS BLVD
Mailing Address - Street 2:MEDPLEX A SUITE 312
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-8050
Mailing Address - Country:US
Mailing Address - Phone:850-517-7330
Mailing Address - Fax:
Practice Address - Street 1:7300 SAND LAKE COMMONS BLVD
Practice Address - Street 2:MEDPLEX A SUITE 312
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8050
Practice Address - Country:US
Practice Address - Phone:321-222-4152
Practice Address - Fax:407-574-8233
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN46334207X00000X
FLME0053893207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I209951Medicare PIN
FLE75787Medicare UPIN