Healthcare Provider Details

I. General information

NPI: 1073880431
Provider Name (Legal Business Name): JOGI PATTISAPU, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2011
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 BONNIE LOCH CT
ORLANDO FL
32806-2908
US

IV. Provider business mailing address

80 BONNIE LOCH CT
ORLANDO FL
32806-2908
US

V. Phone/Fax

Practice location:
  • Phone: 407-730-3102
  • Fax: 407-730-3105
Mailing address:
  • Phone: 407-730-3102
  • Fax: 407-730-3105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JOGI PATTISAPU
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 407-730-3102