=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063086601
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NAPLES CONCIERGE CARDIOLOGY AND INTERNAL MEDICINE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2021
-----------------------------------------------------
Last Update Date | 07/28/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 625 9TH ST N, SUITE 104
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34102-8143
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-963-9788
-----------------------------------------------------
Fax | 239-963-9771
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 625 9TH ST N, SUITE 104
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34102-8143
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-963-9788
-----------------------------------------------------
Fax | 239-963-9771
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. SAJAN RAO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 239-963-9788
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------