Healthcare Provider Details

I. General information

NPI: 1093752826
Provider Name (Legal Business Name): SEJAL S KUTHIALA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 06/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5742 BOOTH RD SUITE A
JACKSONVILLE FL
32207-5982
US

IV. Provider business mailing address

7015 AC SKINNER PARKWAY SUITE 1
JACKSONVILLE FL
32256
US

V. Phone/Fax

Practice location:
  • Phone: 904-739-7779
  • Fax: 904-739-7771
Mailing address:
  • Phone: 904-363-2113
  • Fax: 904-538-3672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberME 95618
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: