Provider Demographics
NPI:1124253281
Name:SIROTZKY, LUIS (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:
Last Name:SIROTZKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4857 HEARN RD
Mailing Address - Street 2:
Mailing Address - City:CHATTAHOOCHEE HILLS
Mailing Address - State:GA
Mailing Address - Zip Code:30268
Mailing Address - Country:US
Mailing Address - Phone:561-236-2681
Mailing Address - Fax:
Practice Address - Street 1:4857 HEARN RD
Practice Address - Street 2:
Practice Address - City:CHATTAHOOCHEE HILLS
Practice Address - State:GA
Practice Address - Zip Code:30268
Practice Address - Country:US
Practice Address - Phone:561-236-2681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA86279207R00000X
FLME104350207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL650837261OtherHUMANA HEALTH PLAN