Healthcare Provider Details

I. General information

NPI: 1144786906
Provider Name (Legal Business Name): COMPREHENSIVE HEMATOLOGY ONCOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2019
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 PARK ST N STE 1017
SAINT PETERSBURG FL
33709-2236
US

IV. Provider business mailing address

3611 LITTLE RD
TRINITY FL
34655-1813
US

V. Phone/Fax

Practice location:
  • Phone: 727-344-6570
  • Fax: 727-384-4388
Mailing address:
  • Phone: 727-312-4300
  • Fax: 727-312-4335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

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