MEDICARE: MED-MANAGE 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	208100000X	Physical Medicine & Rehabilitation Physician	ME92179	FL
2	2084N0400X	Neurology Physician	ME55094	FL

General Provider Information

NPI Number	:	1821429523
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MED-MANAGE GROUP, INC

Provider Business Mailing Address
First Line	:	2100 LAKE IDA RD STE 1
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-2442
Country	:	US
Telephone Number	:	561-265-1116
Fax Number	:	561-265-1296

Provider Business Practice Location Address
First Line	:	2100 LAKE IDA RD STE 1
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-2442
Country	:	US
Telephone Number	:	561-265-1116
Fax Number	:	561-265-1296

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEVEN BOTTARI
Credential	:	PH.D
Telephone Number	:	561-265-1116

Provider Enumeration Date	:	12/05/2013
Last Update Date	:	12/05/2013

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Directions to “MED-MANAGE GROUP, INC ” Practice Location

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