MEDICARE: CITYCARE HEALTH 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	261Q00000X	Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1174555098	OTHER	FL	DR. DUCHESNEAU NPI

General Provider Information

NPI Number	:	1649555806
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITYCARE HEALTH INC.

Provider Business Mailing Address
First Line	:	1612 W WATERS AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-2761
Country	:	US
Telephone Number	:	813-283-1277
Fax Number	:	813-283-1279

Provider Business Practice Location Address
First Line	:	1612 W WATERS AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-2761
Country	:	US
Telephone Number	:	813-283-1277
Fax Number	:	813-283-1279

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL A DUCHESNEAU
Credential	:	M.D
Telephone Number	:	813-283-1279

Provider Enumeration Date	:	10/19/2011
Last Update Date	:	12/29/2011

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Directions to “CITYCARE HEALTH INC. ” Practice Location

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