Healthcare Provider Details

I. General information

NPI: 1780171306
Provider Name (Legal Business Name): MORTEZA SADEH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 E COUNTY ROAD 540A FL 2
LAKELAND FL
33813-3825
US

IV. Provider business mailing address

2300 E COUNTY ROAD 540A FL 2
LAKELAND FL
33813-3825
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-7550
  • Fax: 321-841-8185
Mailing address:
  • Phone: 321-841-7550
  • Fax: 321-841-8185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME183190
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: