| Purple Dogfish Llc | |
|
6150 Edgelake Dr Sarasota FL 34240-8803 | |
| (541) 954-3698 | |
| Not Available |
| Full Name | Purple Dogfish Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 6150 Edgelake Dr, Sarasota, Florida |
| Authorized Official Name and Position | Melissa Marie Odermann (DO) |
| Authorized Official Contact | 5419543698 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Purple Dogfish Llc Po Box 18186 Sarasota FL 34276-1186 Ph: () - | Purple Dogfish Llc 6150 Edgelake Dr Sarasota FL 34240-8803 Ph: (541) 954-3698 |
| NPI Number | 1588215362 |
|---|---|
| Provider Enumeration Date | 09/24/2019 |
| Last Update Date | 09/29/2020 |
| Medicare PECOS PAC ID | 7618309287 |
|---|---|
| Medicare Enrollment ID | O20191120000887 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588215362 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Melissa M Odermann |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891081238 PECOS PAC ID: 0840420535 Enrollment ID: I20140225000729 |
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