MEDICARE: MEDICAL PHYSICIANS GROUP 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	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1124461124	OTHER		NPI

General Provider Information

NPI Number	:	1114408648
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL PHYSICIANS GROUP PLLC

Provider Business Mailing Address
First Line	:	PO BOX 186
Second Line	:	UNIT 186
City	:	MACCLENNY
State	:	FL
Zip	:	32063
Country	:	US
Telephone Number	:	863-874-0898
Fax Number	:

Provider Business Practice Location Address
First Line	:	290 NW PEACOCK BLVD # 880891
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34986-2205
Country	:	US
Telephone Number	:	816-398-8916
Fax Number	:

Authorized Official
Title or Position	:	CEO/PHYSICIAN
Name	:	DR. PAT LEUNG
Credential	:	MD
Telephone Number	:	863-874-0898

Provider Enumeration Date	:	08/23/2018
Last Update Date	:	01/14/2019

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