Healthcare Provider Details

I. General information

NPI: 1508856576
Provider Name (Legal Business Name): SREENIVASAN ASOKAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SREENIVASA ASOKAN M.D.

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 10/04/2007
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

PO BOX 692529
ORLANDO FL
32869-2529
US

V. Phone/Fax

Practice location:
  • Phone: 407-931-2816
  • Fax: 407-931-3485
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 Number0055477
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: