Individual
SUSHRUTH EDLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8575 NE 138TH LN STE 203, LADY LAKE, FL 32159-8996
(352) 674-2080
Mailing address
8575 NE 138TH LN STE 203, LADY LAKE, FL 32159-8996
(636) 933-5055
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
57.020812
OH
207RC0000X
Cardiovascular Disease Physician
2019014001
MO
207RI0011X
Interventional Cardiology Physician
2019014001
MO
207RI0011X
Interventional Cardiology Physician
Primary
ME177940
FL
390200000X
Student in an Organized Health Care Education/Training Program
57.020812
OH
Other
Enumeration date
07/23/2012
Last updated
04/15/2026
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