MEDICARE: DR. BRINDA GNANASHANMUGAM M.D

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	207R00000X	Internal Medicine Physician	ME39459	FL

General Provider Information

NPI Number	:	1679586200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRINDA GNANASHANMUGAM M.D

Provider Business Mailing Address
First Line	:	121 GRAHAM ST SW
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-9122
Country	:	US
Telephone Number	:	941-743-4386
Fax Number	:	941-743-4386

Provider Business Practice Location Address
First Line	:	514 E GRACE ST
Second Line	:
City	:	PUNTA GORDA
State	:	FL
Zip	:	33950-6121
Country	:	US
Telephone Number	:	941-833-3500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	07/08/2007

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