Healthcare Provider Details

I. General information

NPI: 1659633972
Provider Name (Legal Business Name): LINDSAY MARTIN KISSANE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 09/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N ORANGE AVE STE 240
ORLANDO FL
32804-4641
US

IV. Provider business mailing address

2501 N ORANGE AVE STE 240
ORLANDO FL
32804-4641
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-1380
  • Fax: 407-303-1385
Mailing address:
  • Phone: 407-303-1380
  • Fax: 407-303-1385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35209
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberME141865
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: