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General NPI Number Information
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NPI Number | 1639613565
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Entity Type | Organization
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Legal Business Name | WEST COLONIAL URGENT CARE
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Dates
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Enumeration Date | 12/12/2016
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Last Update Date | 12/12/2016
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Provider Practice Location Address
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Address Line | 4220 W COLONIAL DR SUITE 3
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City | ORLANDO
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State | FL
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Zip | 32808-8174
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Country | US
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Telephone | 407-270-5124
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Fax | 407-270-5125
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Provider Business Mailing Address
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Address Line | 4220 W COLONIAL DR SUITE 3
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City | ORLANDO
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State | FL
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Zip | 32808-8174
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Country | US
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Telephone | 407-270-5124
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Fax | 407-270-5125
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | SRUJANI GADDAM
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Credential | M.D.
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Telephone | 407-270-5124
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | ME125820
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License Number State | FL
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