Provider Demographics
NPI:1215462601
Name:ANITA SALUJA MD LLC
Entity type:Organization
Organization Name:ANITA SALUJA MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJESH
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-223-1707
Mailing Address - Street 1:2758 WYNDHAM WAY
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-5970
Mailing Address - Country:US
Mailing Address - Phone:321-223-1707
Mailing Address - Fax:
Practice Address - Street 1:6559 N WICKHAM RD STE C105
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-2039
Practice Address - Country:US
Practice Address - Phone:321-241-1160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82777261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH47047Medicare UPIN