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Individual

DR. SUSEELA PIDURU

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.,

Contact information

Practice address
4927 VAN DYKE RD, LUTZ, FL 33558-4813
(813) 960-3919
(813) 960-8414
Mailing address
4927 VAN DYKE RD, LUTZ, FL 33558-4813
(813) 960-3919
(813) 960-8414

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME44800
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
046849500
FL
01
ME44800
MEDICAL LICENSE
FL
Enumeration date
05/02/2006
Last updated
05/29/2012
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