Healthcare Provider Details

I. General information

NPI: 1871549287
Provider Name (Legal Business Name): MANU SEHGAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 02/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 S COURT AVE APT 2602
ORLANDO FL
32801-3205
US

IV. Provider business mailing address

155 S COURT AVE APT 2602
ORLANDO FL
32801-3205
US

V. Phone/Fax

Practice location:
  • Phone: 407-496-7611
  • Fax:
Mailing address:
  • Phone: 407-496-7611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD63340
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberME100529
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: