MEDICARE: LEAH MUGO MD

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	207Q00000X	Family Medicine Physician	036130917	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	33181	OTHER	FL	BCBS FLORIDA

General Provider Information

NPI Number	:	1679700694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH MUGO MD

Provider Business Mailing Address
First Line	:	PO BOX 863407
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32886-3407
Country	:	US
Telephone Number	:	941-917-2600
Fax Number	:	941-917-7884

Provider Business Practice Location Address
First Line	:	2345 BOBCAT VILLAGE CENTER RD
Second Line	:	SUITE202
City	:	NORTH PORT
State	:	FL
Zip	:	34288-8999
Country	:	US
Telephone Number	:	941-257-2930
Fax Number	:	941-257-2923

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

Provider Enumeration Date	:	06/17/2009
Last Update Date	:	10/05/2015

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Directions to “ LEAH MUGO MD” Practice Location

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