MEDICARE: BAYCARE 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	207R00000X	Internal Medicine Physician
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1770153579
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAYCARE MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	2995 DREW ST FL 3
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33759-3012
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2939 ALT 19
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34683-1928
Country	:	US
Telephone Number	:	727-547-8425
Fax Number	:	813-635-2699

Authorized Official
Title or Position	:	VP, PFS
Name	:	LYNDA GORKEN
Credential	:
Telephone Number	:	727-281-9202

Provider Enumeration Date	:	06/25/2021
Last Update Date	:	06/25/2021

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