Healthcare Provider Details

I. General information

NPI: 1992306401
Provider Name (Legal Business Name): ADAPTIVE MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2123 GROVE ST
SARASOTA FL
34239-4622
US

IV. Provider business mailing address

2123 GROVE ST
SARASOTA FL
34239-4622
US

V. Phone/Fax

Practice location:
  • Phone: 239-209-1415
  • Fax:
Mailing address:
  • Phone: 239-209-1415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER MATTHEW DUFFY
Title or Position: OWNER
Credential: PA-C
Phone: 239-209-1415