Healthcare Provider Details

I. General information

NPI: 1376074286
Provider Name (Legal Business Name): KEROLOS ABADEER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KEROLOS ABADEER SEDKI SENADA MD

II. Dates (important events)

Enumeration Date: 03/22/2017
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 WELLS RD
ORANGE PARK FL
32073-2301
US

IV. Provider business mailing address

4800 BELFORT RD
JACKSONVILLE FL
32256-6004
US

V. Phone/Fax

Practice location:
  • Phone: 42-649-7979
  • Fax: 904-264-4644
Mailing address:
  • Phone: 904-398-3385
  • Fax: 904-265-4807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME161157
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: