MEDICARE: TAMPA PHYSICIANS GROUP

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	207R00000X	Internal Medicine Physician	ME 105419	FL

General Provider Information

NPI Number	:	1316229545
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAMPA PHYSICIANS GROUP

Provider Business Mailing Address
First Line	:	2643 CALDWELL RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30319-3118
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6709 RIDGE RD
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-6834
Country	:	US
Telephone Number	:	832-236-2090
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. RAKESH KOTHARI
Credential	:	D.C.
Telephone Number	:	832-236-2090

Provider Enumeration Date	:	09/14/2011
Last Update Date	:	09/14/2011

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