MEDICARE: SUNCOAST HEART CLINIC P A

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	207Q00000X	Family Medicine Physician	ME103805	FL
2	207R00000X	Internal Medicine Physician	ME42408	FL
3	207R00000X	Internal Medicine Physician	ME95837	FL
4	207RC0000X	Cardiovascular Disease Physician	ME42408	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000LX	OTHER	FL	BC/BS OF FL

General Provider Information

NPI Number	:	1316968472
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNCOAST HEART CLINIC P A

Provider Business Mailing Address
First Line	:	5537 GULF DR
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-4021
Country	:	US
Telephone Number	:	727-849-2600
Fax Number	:	727-847-7703

Provider Business Practice Location Address
First Line	:	5537 GULF DR
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-4021
Country	:	US
Telephone Number	:	727-849-2600
Fax Number	:	727-847-7703

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. AKSHAY DHIRUBHAI DESAI
Credential	:	M.D.
Telephone Number	:	727-849-2600

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	08/12/2011

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Directions to “SUNCOAST HEART CLINIC P A ” Practice Location

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