Healthcare Provider Details

I. General information

NPI: 1124253281
Provider Name (Legal Business Name): LUIS SIROTZKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 07/31/2023
Certification Date: 07/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4857 HEARN RD
CHATTAHOOCHEE HILLS GA
30268
US

IV. Provider business mailing address

4857 HEARN RD
CHATTAHOOCHEE HILLS GA
30268
US

V. Phone/Fax

Practice location:
  • Phone: 561-236-2681
  • Fax:
Mailing address:
  • Phone: 561-236-2681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number86279
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: