MEDICARE: MID-FLORIDA MEDICAL GROUP PA

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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DA7068	OTHER	FL	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	31587	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1588727168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID-FLORIDA MEDICAL GROUP PA

Provider Business Mailing Address
First Line	:	PO BOX 218
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34478-0218
Country	:	US
Telephone Number	:	352-751-5055
Fax Number	:	352-751-5056

Provider Business Practice Location Address
First Line	:	910 OLD CAMP RD BLDG 150
Second Line	:	SUITE 154
City	:	LADY LAKE
State	:	FL
Zip	:	32162-5603
Country	:	US
Telephone Number	:	352-751-5055
Fax Number	:	352-751-5056

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. THUMATI GURAPPA JAGALUR
Credential	:	M.D.
Telephone Number	:	352-751-5055

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	03/21/2008

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Directions to “MID-FLORIDA MEDICAL GROUP PA ” Practice Location

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