Provider Demographics
NPI:1376654731
Name:SARASOTA HEALTH GROUP LLC
Entity Type:Organization
Organization Name:SARASOTA HEALTH GROUP LLC
Other - Org Name:DATTOLI CANCER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:F
Authorized Official - Last Name:KALTENBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-955-8088
Mailing Address - Street 1:2803 FRUITVILLE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-5344
Mailing Address - Country:US
Mailing Address - Phone:941-957-4926
Mailing Address - Fax:
Practice Address - Street 1:2803 FRUITVILLE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-5344
Practice Address - Country:US
Practice Address - Phone:941-957-4926
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC7174174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45578Medicare ID - Type Unspecified