Basic Information
| Provider Information | |||||||||
| NPI: | 1417986084 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMBULATORY CARE PHYSICIANS OF SARASOTA LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2401 UNIVERSITY PKWY STE 105 | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342432894 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9419178507 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2401 UNIVERSITY PKWY STE 105 | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342432894 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9419178507 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | KAMM | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9419178507 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 97741 | 01 | FL | BCBS | OTHER |