Healthcare Provider Details

I. General information

NPI: 1215508973
Provider Name (Legal Business Name): BAYCARE MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2021
Last Update Date: 07/05/2021
Certification Date: 07/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 SIMMONS LOOP FL 2
RIVERVIEW FL
33578-9498
US

IV. Provider business mailing address

2995 DREW ST FL 3
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 813-302-8718
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: LYNDA GORKEN
Title or Position: VP, PFS
Credential:
Phone: 727-281-9202