Healthcare Provider Details

I. General information

NPI: 1083742357
Provider Name (Legal Business Name): DIGESTIVE AND LIVER CENTER OF FL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N DEAN RD SUITE 101
ORLANDO FL
32825
US

IV. Provider business mailing address

100 N DEAN RD STE 100
ORLANDO FL
32825-3710
US

V. Phone/Fax

Practice location:
  • Phone: 407-384-7388
  • Fax: 407-384-7391
Mailing address:
  • Phone: 407-384-7388
  • Fax: 407-384-7391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME93786 & ME93637
License Number StateFL

VIII. Authorized Official

Name: SRINIVAS SEELA
Title or Position: PRESIDENT
Credential: MD
Phone: 407-384-7388