Healthcare Provider Details

I. General information

NPI: 1215138847
Provider Name (Legal Business Name): ESENAM LUCINDA KJERULFF M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LUCY ADORKA

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 LEE RD STE 165
WINTER PARK FL
32789-2127
US

IV. Provider business mailing address

1801 LEE RD STE 165
WINTER PARK FL
32789-2127
US

V. Phone/Fax

Practice location:
  • Phone: 407-975-0406
  • Fax: 407-975-0407
Mailing address:
  • Phone: 407-975-0406
  • Fax: 407-975-0407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME109938
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: