MEDICARE: PREVENTIVE CARDIOLOGY & INTERNAL MEDICINE ASSOCIATES, P.L.

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	ME72888	FL

General Provider Information

NPI Number	:	1922343466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREVENTIVE CARDIOLOGY & INTERNAL MEDICINE ASSOCIATES, P.L.

Provider Business Mailing Address
First Line	:	3606 MACLAY BLVD S
Second Line	:	SUITE 104
City	:	TALLAHASSEE
State	:	FL
Zip	:	32312-1277
Country	:	US
Telephone Number	:	850-210-0593
Fax Number	:

Provider Business Practice Location Address
First Line	:	3606 MACLAY BLVD S
Second Line	:	SUITE 104
City	:	TALLAHASSEE
State	:	FL
Zip	:	32312-1277
Country	:	US
Telephone Number	:	850-766-8496
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. SANDEEP RAHANGDALE
Credential	:	M.D.
Telephone Number	:	850-210-0593

Provider Enumeration Date	:	12/10/2012
Last Update Date	:	10/09/2015

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