MEDICARE: FAMILYCARE MEDICAL GROUP, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207R00000X	Internal Medicine Physician
2	207V00000X	Obstetrics & Gynecology Physician
3	363A00000X	Physician Assistant
4	363L00000X	Nurse Practitioner
5	291U00000X	Clinical Medical Laboratory
6	207Q00000X	Family 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	:	1447212063
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILYCARE MEDICAL GROUP, PC

Provider Business Mailing Address
First Line	:	1001 W FAYETTE ST
Second Line	:	STE 400
City	:	SYRACUSE
State	:	NY
Zip	:	13204-2859
Country	:	US
Telephone Number	:	315-472-1488
Fax Number	:	315-883-5405

Provider Business Practice Location Address
First Line	:	1001 W FAYETTE ST
Second Line	:	STE 400
City	:	SYRACUSE
State	:	NY
Zip	:	13204-2859
Country	:	US
Telephone Number	:	315-472-1488
Fax Number	:	315-883-5405

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MITCHELL V BRODEY
Credential	:	MD
Telephone Number	:	315-492-5784

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	03/11/2013

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