Provider Demographics
NPI:1154503654
Name:MID-FLORIDA PULMONARY ASSOCIATES PA
Entity Type:Organization
Organization Name:MID-FLORIDA PULMONARY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SABARETNAM
Authorized Official - Middle Name:
Authorized Official - Last Name:YOGENDRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-483-1960
Mailing Address - Street 1:720 N BAY ST STE 4
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-2964
Mailing Address - Country:US
Mailing Address - Phone:352-483-1960
Mailing Address - Fax:352-483-0660
Practice Address - Street 1:720 N BAY ST STE 4
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726
Practice Address - Country:US
Practice Address - Phone:352-483-1960
Practice Address - Fax:352-483-0660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME55648174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL039648600Medicaid
FL33350Medicare PIN