MEDICARE: ANDRES MEDICAL ASSOCIATES, 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	261QP2300X	Primary Care Clinic/Center
2	207R00000X	Internal Medicine Physician	ME93560	FL

General Provider Information

NPI Number	:	1962926659
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDRES MEDICAL ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	200 2ND AVE S # 224
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33701-4313
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3177 4TH ST N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33704-2124
Country	:	US
Telephone Number	:	877-585-2955
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PIERRE ANDRES PUENTE
Credential	:	MD
Telephone Number	:	877-585-2955

Provider Enumeration Date	:	08/03/2017
Last Update Date	:	03/17/2018

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