MEDICARE: MEDICAL PHYSICIANS GROUP PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QU0200X	Urgent Care Clinic/Center
2	333600000X	Pharmacy
3	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	:	1598245615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL PHYSICIANS GROUP PLLC

Provider Business Mailing Address
First Line	:	PO BOX 880891
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34988-0891
Country	:	US
Telephone Number	:	816-398-8916
Fax Number	:

Provider Business Practice Location Address
First Line	:	290 NW PEACOCK BLVD # 880891
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34986-2205
Country	:	US
Telephone Number	:	816-398-8916
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN/CEO
Name	:	DR. PAT LEUNG
Credential	:	MD
Telephone Number	:	310-928-1896

Provider Enumeration Date	:	08/17/2018
Last Update Date	:	08/17/2018

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