MEDICARE: TGPN M2 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1720865025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TGPN M2 LLC

Provider Business Mailing Address
First Line	:	6415 LAKE WORTH RD STE 102
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33463-3009
Country	:	US
Telephone Number	:	561-331-0808
Fax Number	:

Provider Business Practice Location Address
First Line	:	4620 PGA BLVD STE 101
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-3991
Country	:	US
Telephone Number	:	561-559-0955
Fax Number	:	561-621-9669

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ABRAHAM SCHWARZBERG
Credential	:	MD
Telephone Number	:	561-253-3980

Provider Enumeration Date	:	09/11/2023
Last Update Date	:	09/11/2023

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