Provider Demographics
NPI:1972772937
Name:ISHPAUL MEDICAL, INC.
Entity type:Organization
Organization Name:ISHPAUL MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVINDER
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:BHAMBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-378-3843
Mailing Address - Street 1:5250 17TH ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34235-8242
Mailing Address - Country:US
Mailing Address - Phone:941-378-3843
Mailing Address - Fax:941-378-7864
Practice Address - Street 1:5250 17TH ST
Practice Address - Street 2:SUITE 7
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34235-8242
Practice Address - Country:US
Practice Address - Phone:941-378-3843
Practice Address - Fax:941-378-7864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMR0071115261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2412Medicare PIN
FLG39803Medicare UPIN