MEDICARE: MAINSAIL MEDICAL 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	207Q00000X	Family Medicine Physician	OS7901	FL

General Provider Information

NPI Number	:	1982829099
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAINSAIL MEDICAL INC

Provider Business Mailing Address
First Line	:	625 COMMERCE DR
Second Line	:	SUITE 207
City	:	LAKELAND
State	:	FL
Zip	:	33813-2768
Country	:	US
Telephone Number	:	863-701-7188
Fax Number	:	863-701-2014

Provider Business Practice Location Address
First Line	:	625 COMMERCE DR
Second Line	:	SUITE 207
City	:	LAKELAND
State	:	FL
Zip	:	33813-2768
Country	:	US
Telephone Number	:	863-701-7188
Fax Number	:	863-701-2014

Authorized Official
Title or Position	:	OWNER, PHYSICIAN
Name	:	DR. ROXANN CASTELLI COOK
Credential	:	D.O.
Telephone Number	:	863-701-7188

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	08/22/2020

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Directions to “MAINSAIL MEDICAL INC ” Practice Location

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