MEDICARE: FPG SPECIALISTS 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	207RN0300X	Nephrology Physician

General Provider Information

NPI Number	:	1508130527
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FPG SPECIALISTS CARE, LLC

Provider Business Mailing Address
First Line	:	6416 OLD WINTER GARDEN RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-1348
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6416 OLD WINTER GARDEN RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-1348
Country	:	US
Telephone Number	:	407-253-3535
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DOCTOR
Name	:	ANJALI I. VYAS
Credential	:
Telephone Number	:	407-253-3535

Provider Enumeration Date	:	03/08/2012
Last Update Date	:	06/19/2012

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Directions to “FPG SPECIALISTS CARE, LLC ” Practice Location

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