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General NPI Number Information
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NPI Number | 1407841810
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Entity Type | Organization
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Legal Business Name | TREASURE COAST CANCER CARE CENTER INC
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Dates
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Enumeration Date | 09/13/2005
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Last Update Date | 06/26/2014
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Provider Practice Location Address
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Address Line | 1700 SE HILLMOOR DR STE 306
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-7539
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Country | US
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Telephone | 772-398-6016
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Fax | 772-337-0320
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Provider Business Mailing Address
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Address Line | 1700 SE HILLMOOR DR STE 306
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-7539
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Country | US
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Telephone | 772-398-6016
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Fax | 772-337-0320
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SIVA P BELLAM
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Credential | M.D
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Telephone | 772-398-6016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | ME0070221
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License Number State | FL
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