Organization
ULTIMA SPINE & PAIN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SRIKIRAN POTHAMSETTY MD (OWNER)
(321) 231-3408
Entity
Organization
Contact information
Practice address
1507 S HIAWASSEE RD STE 105, ORLANDO, FL 32835-5706
(321) 231-3408
Mailing address
1507 S HIAWASSEE RD STE 105, ORLANDO, FL 32835-5706
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
208VP0000X
Pain Medicine Physician
—
—
208VP0014X
Interventional Pain Medicine Physician
Primary
—
—
Other
Enumeration date
07/07/2017
Last updated
07/07/2017
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