Healthcare Provider Details

I. General information

NPI: 1639584584
Provider Name (Legal Business Name): SANDEEP KOLA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2014
Last Update Date: 07/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4071 BEE RIDGE RD STE 101
SARASOTA FL
34233-2542
US

IV. Provider business mailing address

4071 BEE RIDGE RD STE 101
SARASOTA FL
34233-2542
US

V. Phone/Fax

Practice location:
  • Phone: 941-371-7171
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberOS15549
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: