Healthcare Provider Details

I. General information

NPI: 1093701120
Provider Name (Legal Business Name): SANJEEV SAXENA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2290 10TH AVE N STE 101
LAKE WORTH FL
33461-6609
US

IV. Provider business mailing address

PO BOX 681239
FORT PAYNE AL
35968-1613
US

V. Phone/Fax

Practice location:
  • Phone: 800-991-6117
  • Fax: 888-812-8191
Mailing address:
  • Phone: 256-997-9200
  • Fax: 256-979-1819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number24558
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME78128
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number24558
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number24558
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: