Provider Demographics
NPI:1225013717
Name:SLADEK, GARY DEAN (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:DEAN
Last Name:SLADEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2501 N ORANGE AVE
Mailing Address - Street 2:538
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4603
Mailing Address - Country:US
Mailing Address - Phone:407-894-8696
Mailing Address - Fax:407-894-4196
Practice Address - Street 1:2501 N ORANGE AVE
Practice Address - Street 2:538
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4603
Practice Address - Country:US
Practice Address - Phone:407-894-8696
Practice Address - Fax:407-894-4196
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME33060207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D82418Medicare UPIN
30358Medicare ID - Type Unspecified