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General NPI Number Information
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NPI Number | 1306516208
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Entity Type | Organization
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Legal Business Name | INTERCOASTAL MEDICAL GROUP INC
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Dates
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Enumeration Date | 09/14/2021
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Last Update Date | 09/14/2021
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Provider Practice Location Address
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Address Line | 11715 RANGELAND PKWY
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City | BRADENTON
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State | FL
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Zip | 34211-9529
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Country | US
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Telephone | 941-538-0001
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Fax |
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Provider Business Mailing Address
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Address Line | 943 S BENEVA RD STE 306
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City | SARASOTA
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State | FL
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Zip | 34232-2473
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Country | US
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Telephone | 941-955-1108
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Fax | 941-954-4440
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN M STEELE
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Credential |
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Telephone | 941-953-5213
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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