Healthcare Provider Details

I. General information

NPI: 1326074634
Provider Name (Legal Business Name): MEDICALT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1931 S TUTTLE AVE
SARASOTA FL
34239-3115
US

IV. Provider business mailing address

1931 S TUTTLE AVE
SARASOTA FL
34239-3115
US

V. Phone/Fax

Practice location:
  • Phone: 941-957-4500
  • Fax: 941-957-4501
Mailing address:
  • Phone: 941-957-4500
  • Fax: 941-957-4501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: NEIL TREITMAN
Title or Position: OWNER
Credential:
Phone: 941-957-4500