Organization
PHYSICIAN PROVIDERS GROUP PA
Active
Other names
COMPREHENSIVE PAIN MANAGEMENT CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT ULSETH MD (MD/OWNER)
(352) 344-4791
Entity
Organization
Contact information
Practice address
305 S LINE AVE, INVERNESS, FL 34452-4605
(352) 344-4791
(352) 344-3822
Mailing address
PO BOX 1925, LADY LAKE, FL 32158-1925
(523) 553-4075
(888) 770-3208
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34759
BLUE SHIELD PROV #
FL
Enumeration date
09/12/2005
Last updated
07/03/2023
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