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General NPI Number Information
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NPI Number | 1639244999
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Entity Type | Organization
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Legal Business Name | SANJAY K MADAN MD PA
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3190 MCMULLEN BOOTH RD STE 201
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City | CLEARWATER
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State | FL
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Zip | 33761
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Country | US
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Telephone | 727-669-2969
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Fax | 727-669-7460
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Provider Business Mailing Address
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Address Line | 3190 MCMULLEN BOOTH RD STE 201
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City | CLEARWATER
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State | FL
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Zip | 33761
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Country | US
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Telephone | 727-669-2969
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Fax | 727-669-7460
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Authorized Official
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Title or Position | OWNER
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Name | SANJAY K MADAN
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Credential | MD
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Telephone | 727-669-2969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME0073402
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License Number State | FL
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