Provider Demographics
NPI:1417986084
Name:AMBULATORY CARE PHYSICIANS OF SARASOTA LLC
Entity Type:Organization
Organization Name:AMBULATORY CARE PHYSICIANS OF SARASOTA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:W
Authorized Official - Last Name:KAMM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-917-8507
Mailing Address - Street 1:2401 UNIVERSITY PKWY STE 105
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-2894
Mailing Address - Country:US
Mailing Address - Phone:941-917-8507
Mailing Address - Fax:
Practice Address - Street 1:2401 UNIVERSITY PKWY STE 105
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2894
Practice Address - Country:US
Practice Address - Phone:941-917-8507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL97741OtherBCBS
=========OtherCHAMPUS/TRICARE
FLK9394Medicare ID - Type Unspecified