MEDICARE: DR. TRACY NG D.O.

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	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	OS13388	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	:	1861623209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRACY NG D.O.

Provider Business Mailing Address
First Line	:	1641 TAMIAMI TRL STE 1
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33948-1018
Country	:	US
Telephone Number	:	419-629-6262
Fax Number	:	419-629-1782

Provider Business Practice Location Address
First Line	:	836 SUNSET LAKE BLVD STE 102
Second Line	:
City	:	VENICE
State	:	FL
Zip	:	34292-7555
Country	:	US
Telephone Number	:	941-497-1771
Fax Number	:	941-492-9475

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2009
Last Update Date	:	05/15/2023

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Directions to “ DR. TRACY NG D.O.” Practice Location

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