Provider Demographics
NPI:1073880431
Name:JOGI PATTISAPU, MD, PA
Entity Type:Organization
Organization Name:JOGI PATTISAPU, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOGI
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTISAPU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-730-3102
Mailing Address - Street 1:80 BONNIE LOCH CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2908
Mailing Address - Country:US
Mailing Address - Phone:407-730-3102
Mailing Address - Fax:407-730-3105
Practice Address - Street 1:80 BONNIE LOCH CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2908
Practice Address - Country:US
Practice Address - Phone:407-730-3102
Practice Address - Fax:407-730-3105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty