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	207RI0011X	Interventional Cardiology Physician

General Provider Information

NPI Number	:	1396489225
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	:	1202 S CHURCH AVE STE A
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-5017
Country	:	US
Telephone Number	:	813-821-8095
Fax Number	:	813-821-8309

Authorized Official
Title or Position	:	VP CARE TRANSITIONS
Name	:	PETER TRAVIS RIAD CHANG
Credential	:
Telephone Number	:	813-844-3956

Provider Enumeration Date	:	04/26/2022
Last Update Date	:	12/19/2025

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