Healthcare Provider Details

I. General information

NPI: 1972891000
Provider Name (Legal Business Name): GOURI SREEPATI M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2011
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 CORAL HILLS DR STE 240250
CORAL SPRINGS FL
33065-4146
US

IV. Provider business mailing address

1608 SE 3RD AVE FL 3
FORT LAUDERDALE FL
33316-2564
US

V. Phone/Fax

Practice location:
  • Phone: 954-344-3233
  • Fax: 954-888-3828
Mailing address:
  • Phone: 954-344-3233
  • Fax: 954-888-3828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME146160
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: