MEDICARE: BLESSINGS MEDICAL GROUP, LLC

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1679094916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLESSINGS MEDICAL GROUP, LLC

Provider Business Mailing Address
First Line	:	3527 KNOLLWOOD RD
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-6414
Country	:	US
Telephone Number	:	239-707-4459
Fax Number	:

Provider Business Practice Location Address
First Line	:	418 SW 47TH TER
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-6506
Country	:	US
Telephone Number	:	239-945-1919
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	KEITH A BAKER
Credential	:	DO
Telephone Number	:	239-945-1919

Provider Enumeration Date	:	06/27/2017
Last Update Date	:	06/27/2017

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