Provider Demographics
NPI:1760460679
Name:YOGENDRA, SABARETNAM (MD)
Entity Type:Individual
Prefix:
First Name:SABARETNAM
Middle Name:
Last Name:YOGENDRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME55648207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL039648600Medicaid
FL09145Medicare ID - Type Unspecified