Healthcare Provider Details

I. General information

NPI: 1346745122
Provider Name (Legal Business Name): INDEPENDENT MULTISPECIALTY GROUP OF FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1447 MEDICAL PARK BLVD STE 405
WELLINGTON FL
33414-3183
US

IV. Provider business mailing address

1447 MEDICAL PARK BLVD STE 405
WELLINGTON FL
33414-3183
US

V. Phone/Fax

Practice location:
  • Phone: 904-334-0910
  • Fax: 561-363-2597
Mailing address:
  • Phone: 904-334-0910
  • Fax: 561-363-2597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SRIINIVAS KAZA
Title or Position: OWNER
Credential: MD
Phone: 561-767-8342