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Organization
MID-FLORIDA MEDICAL GROUP PA
Active
Organization
MID-FLORIDA MEDICAL GROUP PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THUMATI GURAPPA JAGALUR M.D. (PRESIDENT)
(352) 751-5055
Entity
Organization
Contact information
Practice address
910 OLD CAMP RD BLDG 150, SUITE 154, LADY LAKE, FL 32162-5603
(352) 751-5055
(352) 751-5056
Mailing address
PO BOX 218, OCALA, FL 34478-0218
(352) 751-5055
(352) 751-5056
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31587
BCBS
FL
01
—
DA7068
MEDICARE RAILROAD
FL
Enumeration date
12/18/2006
Last updated
03/21/2008
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