Provider Demographics
NPI:1588818983
Name:KIRKMAN MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:KIRKMAN MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SRINIVASAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PILLAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-298-4045
Mailing Address - Street 1:882 S KIRKMAN RD
Mailing Address - Street 2:STE 108A
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-2600
Mailing Address - Country:US
Mailing Address - Phone:407-298-4045
Mailing Address - Fax:
Practice Address - Street 1:882 S KIRKMAN RD
Practice Address - Street 2:STE 108A
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-2600
Practice Address - Country:US
Practice Address - Phone:407-298-4045
Practice Address - Fax:407-298-4046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-11
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
BR082AOtherPTAN