MEDICARE: TAMARAC PHYSICIANS GROUP INC

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	204C00000X	Sports Medicine (Neuromusculoskeletal Medicine) Physician	ME93323	FL
2	207R00000X	Internal Medicine Physician	ME93323	FL
3	111N00000X	Chiropractor	CH3988	FL

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	:	1780887760
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAMARAC PHYSICIANS GROUP INC

Provider Business Mailing Address
First Line	:	8287 NW 88TH AVE
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33321-1541
Country	:	US
Telephone Number	:	954-722-6637
Fax Number	:	954-720-6298

Provider Business Practice Location Address
First Line	:	8287 NW 88TH AVE
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33321-1541
Country	:	US
Telephone Number	:	954-722-6637
Fax Number	:	954-720-6298

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RONALD FELDMAN
Credential	:	D.C.
Telephone Number	:	954-722-6637

Provider Enumeration Date	:	06/07/2007
Last Update Date	:	10/25/2012

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