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General NPI Number Information
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NPI Number | 1003577081
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Entity Type | Organization
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Legal Business Name | SPARTAN MEDICAL GROUP
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Dates
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Enumeration Date | 01/03/2022
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Last Update Date | 01/10/2022
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Provider Practice Location Address
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Address Line | 9145 NARCOOSSEE RD STE A102
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City | ORLANDO
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State | FL
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Zip | 32827-5768
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Country | US
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Telephone | 407-703-6020
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Fax |
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Provider Business Mailing Address
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Address Line | 10524 MOSS PARK RD STE 204-771
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City | ORLANDO
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State | FL
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Zip | 32832-5898
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO/PROVIDER
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Name | KWABENA AMPONSAH
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Credential |
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Telephone | 937-902-2068
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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