Provider Demographics
NPI:1194049445
Name:INTERNATIONAL CENTER FOR ADVANCED SPINE AND ORTHOPEDIC SURGERY LLC
Entity type:Organization
Organization Name:INTERNATIONAL CENTER FOR ADVANCED SPINE AND ORTHOPEDIC SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAJEEV
Authorized Official - Middle Name:K
Authorized Official - Last Name:NAIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-753-1756
Mailing Address - Street 1:1945 VERSAILLES ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-6900
Mailing Address - Country:US
Mailing Address - Phone:941-753-1756
Mailing Address - Fax:941-227-4243
Practice Address - Street 1:712 53RD AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-5827
Practice Address - Country:US
Practice Address - Phone:941-753-1756
Practice Address - Fax:941-227-4243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96223207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty