Healthcare Provider Details

I. General information

NPI: 1194990499
Provider Name (Legal Business Name): SAURABH AGRAWAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 S ORANGE AVE STE 103
ORLANDO FL
32806-2946
US

IV. Provider business mailing address

1717 S ORANGE AVE STE 103
ORLANDO FL
32806-2946
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-4344
  • Fax: 321-843-1753
Mailing address:
  • Phone: 321-841-4344
  • Fax: 321-843-1753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number57.009877
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01070995A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number01070995A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code207RT0003X
TaxonomyTransplant Hepatology Physician
License NumberME129332
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME129332
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: