MEDICARE: MELROSE MEDICAL GROUP PL

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

General Provider Information

NPI Number	:	1306263447
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MELROSE MEDICAL GROUP PL

Provider Business Mailing Address
First Line	:	5818 CENTRE ST
Second Line	:
City	:	MELROSE
State	:	FL
Zip	:	32666-6207
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5818 CENTRE ST
Second Line	:
City	:	MELROSE
State	:	FL
Zip	:	32666-6207
Country	:	US
Telephone Number	:	352-475-3292
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RAKESH SHARMA
Credential	:	MD
Telephone Number	:	503-607-5098

Provider Enumeration Date	:	03/26/2014
Last Update Date	:	03/26/2014

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