Healthcare Provider Details

I. General information

NPI: 1124886098
Provider Name (Legal Business Name): SRSS MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2024
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1588 CITRUS MEDICAL CT
OCOEE FL
34761-4547
US

IV. Provider business mailing address

12503 BOVET AVE
ORLANDO FL
32827-7716
US

V. Phone/Fax

Practice location:
  • Phone: 786-699-1781
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SARAH FATIMA SIDDIQUI
Title or Position: OWNER/PARTNER
Credential: D.O.
Phone: 321-438-1300