MEDICARE: VG PRIMARY CARE PLLC

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	207R00000X	Internal Medicine Physician

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

General Provider Information

NPI Number	:	1003406851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VG PRIMARY CARE PLLC

Provider Business Mailing Address
First Line	:	5285 SUMMERLIN RD STE 101
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-7601
Country	:	US
Telephone Number	:	239-789-2201
Fax Number	:	727-222-1077

Provider Business Practice Location Address
First Line	:	5285 SUMMERLIN RD STE 101
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-7601
Country	:	US
Telephone Number	:	978-495-0389
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. VIKTI GOSALIA
Credential	:
Telephone Number	:	978-495-0389

Provider Enumeration Date	:	01/25/2021
Last Update Date	:	10/21/2021

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Directions to “VG PRIMARY CARE PLLC ” Practice Location

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