MEDICARE: SAJI M PACKAL MD

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME91433	FL

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

General Provider Information

NPI Number	:	1639163660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAJI M PACKAL MD

Provider Business Mailing Address
First Line	:	1601 SW ARCHER RD
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32608-1135
Country	:	US
Telephone Number	:	352-376-1611
Fax Number	:	352-379-4079

Provider Business Practice Location Address
First Line	:	1601 SW ARCHER RD
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32608-1135
Country	:	US
Telephone Number	:	352-376-1611
Fax Number	:	352-379-4079

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	09/24/2013

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