Provider Demographics
NPI:1861046211
Name:SAND LAKE INTERNAL MEDICINE, LLC
Entity Type:Organization
Organization Name:SAND LAKE INTERNAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAJINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:SAHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-284-3552
Mailing Address - Street 1:7300 SANDLAKE COMMONS BLVD STE 221
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-8011
Mailing Address - Country:US
Mailing Address - Phone:407-284-3552
Mailing Address - Fax:407-284-3553
Practice Address - Street 1:7300 SANDLAKE COMMONS BLVD STE 221
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8011
Practice Address - Country:US
Practice Address - Phone:407-284-3552
Practice Address - Fax:407-284-3553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-24
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103778700Medicaid
FLLN816OtherMEDICARE