Provider Demographics
NPI:1861572554
Name:IMFELD, MATTHEW D (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:D
Last Name:IMFELD
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 1:10345 ORANGEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-8239
Mailing Address - Country:US
Mailing Address - Phone:407-352-6900
Mailing Address - Fax:407-352-6163
Practice Address - Street 1:10345 ORANGEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32821-8239
Practice Address - Country:US
Practice Address - Phone:407-352-6900
Practice Address - Fax:407-352-6163
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59982208100000X
OH565856208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
4227385OtherAETNA PPO
4310614008OtherCIGNA
593224058002OtherPRUCARE
FL056017100Medicaid
0961384OtherAETNA QPOS
4227385OtherAETNA POS
0961384OtherAETNA HMO
12657OtherBLUE CROSS BLUE SHIELD
FL056017100Medicaid
593224058002OtherPRUCARE