Healthcare Provider Details

I. General information

NPI: 1558321158
Provider Name (Legal Business Name): VIRESH MOHANLAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 07/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3885 OAKWATER CIR
ORLANDO FL
32806-6257
US

IV. Provider business mailing address

3885 OAKWATER CIR SUITE C
ORLANDO FL
32806-6257
US

V. Phone/Fax

Practice location:
  • Phone: 407-894-4693
  • Fax:
Mailing address:
  • Phone: 407-851-6226
  • Fax: 407-438-0507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0061504
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME109408
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: