Healthcare Provider Details

I. General information

NPI: 1639749195
Provider Name (Legal Business Name): BAYCARE MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 AVENUE F NE STE 9118
WINTER HAVEN FL
33881-4131
US

IV. Provider business mailing address

2995 DREW ST FL 3
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 863-292-4005
  • Fax: 863-292-4005
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

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