MEDICARE: COMPREHENSIVE HEMATOLOGY ONCOLOGY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207RH0000X	Hematology (Internal Medicine) Physician
2	207RX0202X	Medical Oncology Physician
3	207RH0003X	Hematology & Oncology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	6966071	OTHER	FL	AETNA
4	A4Z4F	OTHER	FL	BCBS OF FLORIDA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144786906
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE HEMATOLOGY ONCOLOGY LLC

Provider Business Mailing Address
First Line	:	3611 LITTLE RD
Second Line	:
City	:	TRINITY
State	:	FL
Zip	:	34655-1813
Country	:	US
Telephone Number	:	727-312-4300
Fax Number	:	727-312-4335

Provider Business Practice Location Address
First Line	:	5000 PARK ST N STE 1017
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33709-2236
Country	:	US
Telephone Number	:	727-344-6570
Fax Number	:	727-384-4388

Authorized Official
Title or Position	:	OWNER
Name	:	PRATIBHA KIRIT DESAI
Credential	:	MD
Telephone Number	:	727-344-6569

Provider Enumeration Date	:	02/18/2019
Last Update Date	:	06/20/2024

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