| NPI | 1417099029 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SURESH CHAVAKULA Owner 239-482-2280 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology |
| Additional Taxonomies | 174400000X Specialist |
| 207L00000X Anesthesiology (Licence: FL ME78992) | |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2025-10-22 |