MEDICARE: TAMPA GENERAL MEDICAL GROUP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164769063
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAMPA GENERAL MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	PO BOX 1289
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33601-1289
Country	:	US
Telephone Number	:	813-844-3956
Fax Number	:

Provider Business Practice Location Address
First Line	:	2106 S LOIS AVE
Second Line	:	FL 2
City	:	TAMPA
State	:	FL
Zip	:	33629
Country	:	US
Telephone Number	:	813-844-4200
Fax Number	:	813-844-1919

Authorized Official
Title or Position	:	CHIEF MEDICAL INFORMATICS OFFICER
Name	:	DR. PETER T CHANG
Credential	:	M.D.
Telephone Number	:	813-844-3956

Provider Enumeration Date	:	01/11/2013
Last Update Date	:	12/19/2025

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