MEDICARE: SYCAMORE MED INC,

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	207L00000X	Anesthesiology Physician	ME111281	FL

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	:	1568981082
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYCAMORE MED INC,

Provider Business Mailing Address
First Line	:	17010 VILESTA DR
Second Line	:
City	:	LUTZ
State	:	FL
Zip	:	33548-7209
Country	:	US
Telephone Number	:	917-855-4500
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 W FLETCHER AVE STE 102
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612-3400
Country	:	US
Telephone Number	:	813-679-5276
Fax Number	:	813-354-3638

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LISA PATEL
Credential	:	MD
Telephone Number	:	917-855-4500

Provider Enumeration Date	:	09/15/2017
Last Update Date	:	06/16/2018

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