MEDICARE: INTERCOASTAL MEDICAL GROUP INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	208600000X	Surgery Physician
2	207R00000X	Internal Medicine Physician
3	213ES0103X	Foot & Ankle Surgery Podiatrist
4	208C00000X	Colon & Rectal Surgery Physician
5	207RC0000X	Cardiovascular Disease Physician
6	207RR0500X	Rheumatology Physician
7	207X00000X	Orthopaedic Surgery Physician
8	207Y00000X	Otolaryngology Physician
9	207VG0400X	Gynecology Physician
10	207N00000X	Dermatology Physician
11	207RE0101X	Endocrinology, Diabetes & Metabolism Physician
12	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician
13	207RG0100X	Gastroenterology Physician
14	2084N0400X	Neurology Physician
15	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	24374	OTHER	FL	BLUE CROSS & BLUE SHIELD

General Provider Information

NPI Number	:	1578537767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERCOASTAL MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	943 S BENEVA RD STE 306
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34232-2499
Country	:	US
Telephone Number	:	941-955-1108
Fax Number	:	941-954-4440

Provider Business Practice Location Address
First Line	:	943 S BENEVA RD STE 306
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34232-2499
Country	:	US
Telephone Number	:	941-955-1108
Fax Number	:	941-954-4440

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARK J RAMOS
Credential	:	MD
Telephone Number	:	941-955-1108

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	03/10/2026

Similar Medicare Providers

1356297659 — AWARD CARE AT BENEVA LLC
Practice Location Address:

741 S BENEVA RD
SARASOTA, FL
34232-2411

Practice Phone: 941-957-0310
Practice Fax:

1851247183 — AWARD CARE ASSISTED LIVING AT BENEVA LLC
Practice Location Address:

743 S BENEVA RD
SARASOTA, FL
34232-2411

Practice Phone: 941-316-0151
Practice Fax:

1497076335 — DR. ELIZABETH R RICHTER M.D., PH.D.
Practice Location Address:

2601 CATTLEMEN RD STE 102
SARASOTA, FL
34232-6282

Practice Phone: 941-924-0303
Practice Fax: 941-924-0309

1164468211 — DR. KEYE L WONG M.D.
Practice Location Address:

2601 CATTLEMEN RD STE 102
SARASOTA, FL
34232-6282

Practice Phone: 941-924-0303
Practice Fax: 941-924-0309

1457140642 — DR. NATHAN JOHN LARKIN DMD
Practice Location Address:

5670 FRUITVILLE RD
SARASOTA, FL
34232-6407

Practice Phone: 612-716-4360
Practice Fax:

1467309849 — MICHELLE BAUTISTA
Practice Location Address:

2621 CATTLEMEN RD STE 204
SARASOTA, FL
34232-6212

Practice Phone: 941-326-3223
Practice Fax:

Directions to “INTERCOASTAL MEDICAL GROUP INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.