Provider Demographics
NPI:1154987089
Name:HEALING TREE INTERNAL MEDICINE LLC
Entity type:Organization
Organization Name:HEALING TREE INTERNAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUDANAI
Authorized Official - Middle Name:
Authorized Official - Last Name:SABAPATHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-907-2834
Mailing Address - Street 1:1934 BOTANICA CIR
Mailing Address - Street 2:
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-7333
Mailing Address - Country:US
Mailing Address - Phone:716-907-2834
Mailing Address - Fax:
Practice Address - Street 1:3044 W NEW HAVEN AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-3566
Practice Address - Country:US
Practice Address - Phone:716-907-2834
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-16
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty