Provider Demographics
NPI:1184189169
Name:BELA UROGYNECOLOGY LLC
Entity Type:Organization
Organization Name:BELA UROGYNECOLOGY LLC
Other - Org Name:BELA VIDA UROGYNECOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BELA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUDISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-420-3955
Mailing Address - Street 1:PO BOX 402
Mailing Address - Street 2:
Mailing Address - City:GOTHA
Mailing Address - State:FL
Mailing Address - Zip Code:34734-0402
Mailing Address - Country:US
Mailing Address - Phone:407-982-4852
Mailing Address - Fax:
Practice Address - Street 1:1178 CYPRESS GLEN CIR STE 2
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-7560
Practice Address - Country:US
Practice Address - Phone:407-982-4852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive SurgeryGroup - Single Specialty