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General NPI Number Information
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NPI Number | 1558618116
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Entity Type | Organization
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Legal Business Name | TAVARES SURGERY LLC
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Dates
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Enumeration Date | 08/13/2012
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Last Update Date | 10/24/2024
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Provider Practice Location Address
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Address Line | 1878 MAYO DR
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City | TAVARES
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State | FL
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Zip | 32778-4308
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Country | US
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Telephone | 352-508-5401
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Fax | 877-535-4708
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Provider Business Mailing Address
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Address Line | 1878 MAYO DR
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City | TAVARES
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State | FL
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Zip | 32778-4308
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Country | US
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Telephone | 352-508-5401
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Fax | 877-535-4708
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. SOUNDARAPANDIAN BASKAR
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Credential | M.D.
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Telephone | 352-636-3652
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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