Healthcare Provider Details

I. General information

NPI: 1275761389
Provider Name (Legal Business Name): VISHNU SEECHARAN D.P.M
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2009
Last Update Date: 08/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1094 MILITARY TRL
JUPITER FL
33458-7021
US

IV. Provider business mailing address

1094 MILITARY TRL
JUPITER FL
33458-7021
US

V. Phone/Fax

Practice location:
  • Phone: 561-622-6111
  • Fax: 855-215-9930
Mailing address:
  • Phone: 561-622-6111
  • Fax: 855-215-9930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN006376
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN006376-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: