=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144349853
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SANKARAN SATHEESH BABU M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2007
-----------------------------------------------------
Last Update Date | 12/08/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 27516 ASCOT ST
-----------------------------------------------------
City | WESLEY CHAPEL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33544-5476
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-994-9917
-----------------------------------------------------
Fax | 813-994-9917
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27516 ASCOT ST
-----------------------------------------------------
City | WESLEY CHAPEL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33544-5476
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-994-9917
-----------------------------------------------------
Fax | 813-994-9917
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | 042-0003607
-----------------------------------------------------
License Number State | VT
-----------------------------------------------------