MEDICARE: MERCEDES MONTEALEGRE MD PA

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	ME86105	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	189854	OTHER	FL	AMERIGROUP
2	10324701	OTHER	FL	CITRUS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	291054	OTHER	FL	AVMED
5	81239	OTHER	FL	BLUE CROSS

General Provider Information

NPI Number	:	1467640987
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCEDES MONTEALEGRE MD PA

Provider Business Mailing Address
First Line	:	12171 W LINEBAUGH AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-1732
Country	:	US
Telephone Number	:	813-855-5455
Fax Number	:	813-855-9258

Provider Business Practice Location Address
First Line	:	12171 W LINEBAUGH AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-1732
Country	:	US
Telephone Number	:	813-855-5455
Fax Number	:	813-855-9258

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. MARIA MERCEDES MONTEALEGRE
Credential	:	M.D.
Telephone Number	:	813-855-5455

Provider Enumeration Date	:	10/10/2007
Last Update Date	:	07/21/2016

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