Healthcare Provider Details

I. General information

NPI: 1053985721
Provider Name (Legal Business Name): ENDO SURGICAL CENTER OF KISSIMMEE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 W OAK ST STE 201
KISSIMMEE FL
34741-4936
US

IV. Provider business mailing address

737 W OAK ST STE 201
KISSIMMEE FL
34741-4936
US

V. Phone/Fax

Practice location:
  • Phone: 407-384-7388
  • Fax: 407-384-7391
Mailing address:
  • Phone: 407-384-7388
  • Fax: 407-384-7391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SRINIVAS SEELA
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 407-384-7388