Organization
INNOVATIVE PRIMARY CARE PLC
Active
Other names
Lake Palliative Care Providers
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AJIT VALLABHDAS HANSALIA M.D. (MEMBER)
(352) 638-6493
Entity
Organization
Contact information
Practice address
901 N GROVE ST, EUSTIS, FL 32726-2805
(352) 508-7040
Mailing address
901 N GROVE ST, EUSTIS, FL 32726-2805
(352) 508-7040
Taxonomy
Speciality
Code
Description
License number
State
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H524018710510
DRIVER LICENSE
FL
Enumeration date
09/30/2011
Last updated
02/22/2023
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