Healthcare Provider Details

I. General information

NPI: 1275658213
Provider Name (Legal Business Name): INDEPENDENT ANESTHESIA SERVICES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 10/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 OAK COMMONS BLVD
KISSIMMEE FL
34741-4213
US

IV. Provider business mailing address

9143 GREAT HERON CIR
ORLANDO FL
32836-5486
US

V. Phone/Fax

Practice location:
  • Phone: 407-846-6747
  • Fax:
Mailing address:
  • Phone: 407-876-1604
  • Fax: 407-876-1604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number00554477
License Number StateFL

VIII. Authorized Official

Name: DR. SREENIVASAN ASOKAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 407-876-1604