Healthcare Provider Details

I. General information

NPI: 1821256629
Provider Name (Legal Business Name): SEIFU M DEMISSIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 09/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 N HABANA AVE SUITE 200
TAMPA FL
33614-7160
US

IV. Provider business mailing address

2660 W FAIRBANKS AVE
WINTER PARK FL
32789-3385
US

V. Phone/Fax

Practice location:
  • Phone: 407-898-2767
  • Fax: 407-898-9443
Mailing address:
  • Phone: 407-898-2767
  • Fax: 407-898-9443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberME109533
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: