MEDICARE: MD MEDICARE CHOICE

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	302R00000X	Health Maintenance Organization	H5729	FL

General Provider Information

NPI Number	:	1326222795
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MD MEDICARE CHOICE

Provider Business Mailing Address
First Line	:	5501 W WATERS AVE
Second Line	:	SUITE 401
City	:	TAMPA
State	:	FL
Zip	:	33634-1229
Country	:	US
Telephone Number	:	813-901-9208
Fax Number	:	813-901-9209

Provider Business Practice Location Address
First Line	:	5501 W WATERS AVE
Second Line	:	SUITE 401
City	:	TAMPA
State	:	FL
Zip	:	33634-1229
Country	:	US
Telephone Number	:	813-901-9208
Fax Number	:	813-901-9209

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. JOSE ESPARRA CANSOBRE
Credential	:
Telephone Number	:	18139019208

Provider Enumeration Date	:	12/20/2007
Last Update Date	:	12/20/2007

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