Healthcare Provider Details

I. General information

NPI: 1205438033
Provider Name (Legal Business Name): COMPREHENSIVE HEMATOLOGY ONCOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2020
Last Update Date: 11/09/2024
Certification Date: 11/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15211 CORTEZ BLVD
BROOKSVILLE FL
34613-6072
US

IV. Provider business mailing address

14690 SPRING HILL DR STE 101
SPRING HILL FL
34609-8102
US

V. Phone/Fax

Practice location:
  • Phone: 352-597-4998
  • Fax: 352-596-6051
Mailing address:
  • Phone: 352-799-0046
  • Fax: 352-799-0042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: PRATIBHA KIRIT DESAI
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 727-344-6569