MEDICARE: MEDICINE 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	207R00000X	Internal Medicine Physician	ME104818	FL

General Provider Information

NPI Number	:	1831466911
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICINE GROUP INC

Provider Business Mailing Address
First Line	:	8803 FUTURES DRIVE
Second Line	:	7A
City	:	ORLANDO
State	:	FL
Zip	:	32819
Country	:	US
Telephone Number	:	407-480-2270
Fax Number	:

Provider Business Practice Location Address
First Line	:	8803 FUTURES DR
Second Line	:	7A
City	:	ORLANDO
State	:	FL
Zip	:	32819-9076
Country	:	US
Telephone Number	:	407-480-2270
Fax Number	:	407-480-3455

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROBERT DIAZ
Credential	:	M.D.
Telephone Number	:	407-480-2270

Provider Enumeration Date	:	11/17/2011
Last Update Date	:	09/28/2012

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