MEDICARE: MD AND WELLNESS CENTER 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	207K00000X	Allergy & Immunology Physician
2	261QP2300X	Primary Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922342906
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MD AND WELLNESS CENTER INC

Provider Business Mailing Address
First Line	:	2541 N DALE MABRY HWY UNIT 413
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-2408
Country	:	US
Telephone Number	:	813-876-7700
Fax Number	:	813-876-8700

Provider Business Practice Location Address
First Line	:	4730 N HABANA AVE STE 300
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-7148
Country	:	US
Telephone Number	:	813-876-7700
Fax Number	:	813-876-8700

Authorized Official
Title or Position	:	PRESIDENT/MEDICAL DIRECTOR
Name	:	DR. JOSE LUIS CRUZ
Credential	:	MD
Telephone Number	:	813-876-7700

Provider Enumeration Date	:	11/15/2012
Last Update Date	:	03/23/2022

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