Healthcare Provider Details

I. General information

NPI: 1982014031
Provider Name (Legal Business Name): SANATIVE MEDICAL GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2014
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4315 HIGHLAND PARK BLVD
LAKELAND FL
33813-1639
US

IV. Provider business mailing address

4315 HIGHLAND PARK BLVD
LAKELAND FL
33813-1639
US

V. Phone/Fax

Practice location:
  • Phone: 863-816-5884
  • Fax:
Mailing address:
  • Phone: 863-816-5884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: RENGIT PHILIP
Title or Position: MANAGER
Credential: MD
Phone: 813-816-5884