MEDICARE: SUNCOAST ALLERGY & ASTHMA CENTER

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	207K00000X	Allergy & Immunology Physician		FL

General Provider Information

NPI Number	:	1871680090
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNCOAST ALLERGY & ASTHMA CENTER

Provider Business Mailing Address
First Line	:	6124 53RD AVE E
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34203-9707
Country	:	US
Telephone Number	:	941-758-0588
Fax Number	:	941-739-3564

Provider Business Practice Location Address
First Line	:	6124 53RD AVE E
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34203-9707
Country	:	US
Telephone Number	:	941-758-0588
Fax Number	:	941-739-3564

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. RAJIVI RUCKER
Credential	:	M.D.
Telephone Number	:	941-758-0588

Provider Enumeration Date	:	10/08/2006
Last Update Date	:	08/22/2020

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