Healthcare Provider Details

I. General information

NPI: 1689968299
Provider Name (Legal Business Name): KSENIA A. ORLOVA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 SE MONTEREY COMMONS BLVD STE 300
STUART FL
34996-3329
US

IV. Provider business mailing address

1001 SE MONTEREY COMMONS BLVD STE 300
STUART FL
34996-3329
US

V. Phone/Fax

Practice location:
  • Phone: 772-286-9400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME160459
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: