Provider Demographics
NPI:1477179463
Name:PHYSICIANS PROFESSIONAL ALLIANCE, LLC
Entity Type:Organization
Organization Name:PHYSICIANS PROFESSIONAL ALLIANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:GOPAL
Authorized Official - Middle Name:S
Authorized Official - Last Name:GRANDHIGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-684-6006
Mailing Address - Street 1:519 MEDICAL OAKS AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5961
Mailing Address - Country:US
Mailing Address - Phone:813-685-7995
Mailing Address - Fax:813-685-8802
Practice Address - Street 1:519 MEDICAL OAKS AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5961
Practice Address - Country:US
Practice Address - Phone:813-685-7995
Practice Address - Fax:813-685-8802
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNCOAST SURGICAL ASSOCIATES P A
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-25
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty