MEDICARE: DR. SANJAY K MADAN 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	207R00000X	Internal Medicine Physician	ME0073402	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

General Provider Information

NPI Number	:	1912096645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANJAY K MADAN MD

Provider Business Mailing Address
First Line	:	3190 N MCMULLEN BOOTH RD
Second Line	:	SUITE 201
City	:	CLEARWATER
State	:	FL
Zip	:	33761-2013
Country	:	US
Telephone Number	:	727-669-2969
Fax Number	:	727-669-7460

Provider Business Practice Location Address
First Line	:	3190 N MCMULLEN BOOTH RD
Second Line	:	SUITE 201
City	:	CLEARWATER
State	:	FL
Zip	:	33761-2013
Country	:	US
Telephone Number	:	727-669-2969
Fax Number	:	727-669-7460

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	08/20/2010

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