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NPI Code Detail

MEDICARE: SANJEEV S TENDOLKAR MD LLC

MEDICARE: SANJEEV S TENDOLKAR MD LLC
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
1207Q00000XFamily Medicine Physician63066GA

General Provider Information

NPI Number : 1174878227
Entity Type Code : Organization
Provider Name (Legal Business Name) : SANJEEV S TENDOLKAR MD LLC
Provider Business Mailing Address
First Line : 4589 LAWRENCEVILLE RD
Second Line :
City : LOGANVILLE
State : GA
Zip : 30052-7320
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4589 LAWRENCEVILLE RD
Second Line :
City : LOGANVILLE
State : GA
Zip : 30052-7320
Country : US
Telephone Number : 770-466-8672
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : SANJEEV TENDOLKAR
Credential :
Telephone Number : 770-598-3397
Provider Enumeration Date : 07/16/2012
Last Update Date : 07/16/2012

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