MEDICARE: DR. LUIS SIROTZKY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	86279	GA

General Provider Information

NPI Number	:	1124253281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUIS SIROTZKY MD

Provider Business Mailing Address
First Line	:	4857 HEARN RD
Second Line	:
City	:	CHATTAHOOCHEE HILLS
State	:	GA
Zip	:	30268
Country	:	US
Telephone Number	:	561-236-2681
Fax Number	:

Provider Business Practice Location Address
First Line	:	4857 HEARN RD
Second Line	:
City	:	CHATTAHOOCHEE HILLS
State	:	GA
Zip	:	30268
Country	:	US
Telephone Number	:	561-236-2681
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2009
Last Update Date	:	07/31/2023

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