MEDICARE: ADVANCED MEDICAL CLINIC 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

General Provider Information

NPI Number	:	1891243143
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED MEDICAL CLINIC PA

Provider Business Mailing Address
First Line	:	3347 STATE ROAD 7
Second Line	:	STE 206
City	:	WELLINGTON
State	:	FL
Zip	:	33449-8095
Country	:	US
Telephone Number	:	561-434-1935
Fax Number	:

Provider Business Practice Location Address
First Line	:	1236 ROYAL PALM BEACH BLVD
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-1602
Country	:	US
Telephone Number	:	561-434-1935
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ISHAN A GUNAWARDENE
Credential	:	MD
Telephone Number	:	561-283-0384

Provider Enumeration Date	:	09/15/2016
Last Update Date	:	09/15/2016

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