Provider Demographics
NPI:1013965359
Name:KAMATH, SACHIN SHRINIVAS (MD)
Entity Type:Individual
Prefix:DR
First Name:SACHIN
Middle Name:SHRINIVAS
Last Name:KAMATH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 102222
Mailing Address - Street 2:ATTN: CREDENTIALING DEPARTMENT
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:239-278-3350
Practice Address - Street 1:1400 N US HWY 441
Practice Address - Street 2:SUITE 540
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-8987
Practice Address - Country:US
Practice Address - Phone:352-561-3290
Practice Address - Fax:352-561-3291
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME693322085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012739900Medicaid
FL012739900Medicaid
FLG66226Medicare UPIN