MEDICARE: DR. SANJEEV TANEJA M.D.

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	2085R0202X	Diagnostic Radiology Physician	ME118491	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	ME118491	OTHER	FL	FLORIDA MEDICAL LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629046073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANJEEV TANEJA M.D.

Provider Business Mailing Address
First Line	:	3660 BROADWAY
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-8005
Country	:	US
Telephone Number	:	239-936-2316
Fax Number	:	239-834-6106

Provider Business Practice Location Address
First Line	:	14551 HOPE CENTER LOOP STE 100
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-4705
Country	:	US
Telephone Number	:	239-936-2316
Fax Number	:	239-834-6106

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

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	01/02/2024

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Directions to “ DR. SANJEEV TANEJA M.D.” Practice Location

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