Provider Demographics
NPI:1477609899
Name:FEDORIW, WLADISLAW G (MD)
Entity type:Individual
Prefix:DR
First Name:WLADISLAW
Middle Name:G
Last Name:FEDORIW
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 1:501 N REO ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-1012
Mailing Address - Country:US
Mailing Address - Phone:813-549-2134
Mailing Address - Fax:813-864-4436
Practice Address - Street 1:10875 PARK BLVD STE C
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-5456
Practice Address - Country:US
Practice Address - Phone:727-350-0453
Practice Address - Fax:727-350-0455
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35835207LP2900X, 2081P2900X
FLME168754207LP2900X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1477609899Medicare PIN
AZ116510Medicare UPIN