Healthcare Provider Details

I. General information

NPI: 1184189169
Provider Name (Legal Business Name): BELA UROGYNECOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2019
Last Update Date: 06/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1178 CYPRESS GLEN CIR STE 2
KISSIMMEE FL
34741-7560
US

IV. Provider business mailing address

PO BOX 402
GOTHA FL
34734-0402
US

V. Phone/Fax

Practice location:
  • Phone: 407-982-4852
  • Fax:
Mailing address:
  • Phone: 407-982-4852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BELA KUDISH
Title or Position: CEO
Credential: MD
Phone: 586-420-3955