Basic Information
| Provider Information | |||||||||
| NPI: | 1336209790 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAPE CORAL HOSPITALISTS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13607 PINE VILLA LN | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339121617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2399386192 | ||||||||
| FaxNumber: | 2394244041 | ||||||||
| Practice Location | |||||||||
| Address1: | 13607 PINE VILLA LN | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339121617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2399386192 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2006 | ||||||||
| LastUpdateDate: | 06/12/2020 | ||||||||
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| AuthorizedOfficialLastName: | MAHADEVAN | ||||||||
| AuthorizedOfficialFirstName: | ANAND | ||||||||
| AuthorizedOfficialMiddleName: | RAJ | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2399386192 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 06/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME86995 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 269969900 | 05 | FL | MEDICAID |