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NPI Code Detail

MEDICARE: INTERCOASTAL MEDICAL GROUP INC

MEDICARE: INTERCOASTAL 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
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1306516208
Entity Type Code : Organization
Provider Name (Legal Business Name) : INTERCOASTAL MEDICAL GROUP INC
Provider Business Mailing Address
First Line : 943 S BENEVA RD STE 306
Second Line :
City : SARASOTA
State : FL
Zip : 34232-2473
Country : US
Telephone Number : 941-955-1108
Fax Number : 941-954-4440
Provider Business Practice Location Address
First Line : 11715 RANGELAND PKWY
Second Line :
City : BRADENTON
State : FL
Zip : 34211-9529
Country : US
Telephone Number : 941-538-0001
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : MARK J RAMOS
Credential :
Telephone Number : 941-955-1108
Provider Enumeration Date : 09/14/2021
Last Update Date : 04/08/2026

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Directions to “INTERCOASTAL MEDICAL GROUP INC ” Practice Location

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