Basic Information
| Provider Information | |||||||||
| NPI: | 1982014031 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SANATIVE MEDICAL GROUP PLLC | ||||||||
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| OtherOrganizationName: | HOSPITALISTS OF HAINES CITY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4315 HIGHLAND PARK BLVD | ||||||||
| Address2: | |||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338131639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8638165884 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4315 HIGHLAND PARK BLVD | ||||||||
| Address2: | |||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338131639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8638165884 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2014 | ||||||||
| LastUpdateDate: | 04/29/2014 | ||||||||
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| AuthorizedOfficialLastName: | PHILIP | ||||||||
| AuthorizedOfficialFirstName: | RENGIT | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8138165884 | ||||||||
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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 | 208M00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.