Provider Demographics
NPI:1922643154
Name:ORCHID MEDICAL GROUP LLC
Entity type:Organization
Organization Name:ORCHID MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALFONSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-916-0565
Mailing Address - Street 1:691 S US HIGHWAY 27 # 1
Mailing Address - Street 2:
Mailing Address - City:MOORE HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33471-8301
Mailing Address - Country:US
Mailing Address - Phone:305-820-6211
Mailing Address - Fax:305-822-0116
Practice Address - Street 1:691 S US HIGHWAY 27 # 1
Practice Address - Street 2:
Practice Address - City:MOORE HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33471-8301
Practice Address - Country:US
Practice Address - Phone:305-820-6211
Practice Address - Fax:305-822-0116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-12
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty