MEDICARE: GLADES PRIMARY CARE LLC

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	ME47072	FL

General Provider Information

NPI Number	:	1386820942
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLADES PRIMARY CARE LLC

Provider Business Mailing Address
First Line	:	3347 STATE ROAD 7
Second Line	:	SUITE 200
City	:	WELLINGTON
State	:	FL
Zip	:	33449-8095
Country	:	US
Telephone Number	:	561-996-7742
Fax Number	:	561-798-4779

Provider Business Practice Location Address
First Line	:	1200 S MAIN ST
Second Line	:	SUITE 100
City	:	BELLE GLADE
State	:	FL
Zip	:	33430-7808
Country	:	US
Telephone Number	:	561-996-7742
Fax Number	:	561-798-4779

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	SHEKHAR V SHARMA
Credential	:	MD
Telephone Number	:	561-795-9087

Provider Enumeration Date	:	01/14/2008
Last Update Date	:	04/21/2010

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Directions to “GLADES PRIMARY CARE LLC ” Practice Location

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