MEDICARE: SANJEEV SAXENA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207UN0901X	Nuclear Cardiology Physician	24558	AL
2	207RC0000X	Cardiovascular Disease Physician	ME78128	FL
3	207RC0000X	Cardiovascular Disease Physician	24558	AL
4	207RI0011X	Interventional Cardiology Physician	24558	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	060069630	OTHER	AL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51511919	OTHER	AL	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093701120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANJEEV SAXENA MD

Provider Business Mailing Address
First Line	:	PO BOX 681239
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35968-1613
Country	:	US
Telephone Number	:	256-997-9200
Fax Number	:	256-979-1819

Provider Business Practice Location Address
First Line	:	2290 10TH AVE N STE 101
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-6609
Country	:	US
Telephone Number	:	800-991-6117
Fax Number	:	888-812-8191

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	08/13/2020

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Directions to “ SANJEEV SAXENA MD” Practice Location

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