Provider Demographics
NPI:1821476375
Name:PREVENTIVE MEDICINE OF SARASOTA, PA
Entity Type:Organization
Organization Name:PREVENTIVE MEDICINE OF SARASOTA, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BUBINAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-400-4965
Mailing Address - Street 1:1853 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-4509
Mailing Address - Country:US
Mailing Address - Phone:941-366-3848
Mailing Address - Fax:
Practice Address - Street 1:9114 TOWN CENTER PKWY
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-5053
Practice Address - Country:US
Practice Address - Phone:941-351-4949
Practice Address - Fax:941-351-3033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-15
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME29207207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLB152-486-42-373-0OtherDRIVER LICENSE