Provider Demographics
NPI:1992306401
Name:ADAPTIVE MEDICAL LLC
Entity type:Organization
Organization Name:ADAPTIVE MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:DUFFY
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:239-209-1415
Mailing Address - Street 1:2123 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-4622
Mailing Address - Country:US
Mailing Address - Phone:239-209-1415
Mailing Address - Fax:
Practice Address - Street 1:2123 GROVE ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-4622
Practice Address - Country:US
Practice Address - Phone:239-209-1415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty