MEDICARE: ASSOCIATES IN GERIATRIC MEDICINE 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	207QG0300X	Geriatric Medicine (Family Medicine) Physician

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	:	1790015717
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSOCIATES IN GERIATRIC MEDICINE LLC

Provider Business Mailing Address
First Line	:	6503 PLANTATION PRESERVE CIR N
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33966-8366
Country	:	US
Telephone Number	:	727-798-0482
Fax Number	:

Provider Business Practice Location Address
First Line	:	6503 PLANTATION PRESERVE CIR N
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33966-8366
Country	:	US
Telephone Number	:	727-798-0482
Fax Number	:

Authorized Official
Title or Position	:	OFFICEMANAGER
Name	:	PRASAD KASIREDDY
Credential	:
Telephone Number	:	503-490-4362

Provider Enumeration Date	:	01/14/2010
Last Update Date	:	07/30/2015

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