Individual
IVAN SOOSAIPILLAI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3306 SW 26TH AVE, SUITE 104, OCALA, FL 34471-7856
(352) 622-2020
(352) 622-2025
Mailing address
3306 SW 26TH AVE, SUITE 104, OCALA, FL 34471-7856
(352) 622-2020
(352) 622-2025
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
ME95964
FL
207RI0200X
Infectious Disease Physician
Primary
ME95964
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
279943000
—
FL
01
—
56424
BCBS
FL
01
—
P00750221
RR MEDICARE
FL
Enumeration date
08/05/2006
Last updated
07/07/2011
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