Provider Demographics
NPI:1366052102
Name:DOCTORS OF CLINICAL SPECIALTIES LLC
Entity type:Organization
Organization Name:DOCTORS OF CLINICAL SPECIALTIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:BAJAJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-215-6326
Mailing Address - Street 1:483 N SEMORAN BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3800
Mailing Address - Country:US
Mailing Address - Phone:407-500-3627
Mailing Address - Fax:
Practice Address - Street 1:801 W OAK ST STE 202
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-6609
Practice Address - Country:US
Practice Address - Phone:407-500-3627
Practice Address - Fax:407-930-4353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site