Provider Demographics
NPI:1932486321
Name:SOUTH TAMPA SURGICAL PLLC
Entity Type:Organization
Organization Name:SOUTH TAMPA SURGICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MIT
Authorized Official - Middle Name:
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-866-1959
Mailing Address - Street 1:508 S HABANA AVE
Mailing Address - Street 2:SUITE 380
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4181
Mailing Address - Country:US
Mailing Address - Phone:813-875-9739
Mailing Address - Fax:813-873-2603
Practice Address - Street 1:508 S HABANA AVE
Practice Address - Street 2:SUITE 380
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4181
Practice Address - Country:US
Practice Address - Phone:813-875-9739
Practice Address - Fax:813-873-2603
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUTZ SURGICAL PARTNERS PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty