| Gautam Ganguly, | |
|
3775 N Lecanto Hwy, Beverly Hills, FL 34465-3559 | |
| (352) 746-0600 | |
| (352) 746-0607 |
| Full Name | Gautam Ganguly |
|---|---|
| Gender | Male |
| Speciality | General Practice |
| Location | 3775 N Lecanto Hwy, Beverly Hills, Florida |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669849824 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | 019167 (Puerto Rico) | Secondary |
| 208D00000X | General Practice | ACN1448 (Florida) | Primary |
| Entity Name | Integrate Community Health System |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1467674713 PECOS PAC ID: 6507760469 Enrollment ID: O20040209000113 |
| Mailing Address | Practice Location Address |
|---|---|
| Gautam Ganguly, Po Box 640573, Ste 146, Beverly Hills, FL 34464-0573 Ph: (352) 746-0600 | Gautam Ganguly, 3775 N Lecanto Hwy, Beverly Hills, FL 34465-3559 Ph: (352) 746-0600 |
Dr. Odelsa Diaz Andres, M.D General Practice Medicare: Accepting Medicare Assignments Practice Location: 6279 N Lecanto Hwy, Beverly Hills, FL 34465 Phone: 352-522-0094 Fax: 352-522-0098 | |
Dr. Juan Galvan, MD General Practice Medicare: Accepting Medicare Assignments Practice Location: 6279 N Lecanto Hwy, Beverly Hills, FL 34465 Phone: 352-522-0094 Fax: 352-522-0098 | |
Francis J Mercado-miranda, MD General Practice Medicare: Accepting Medicare Assignments Practice Location: 6279 N Lecanto Hwy, Beverly Hills, FL 34465 Phone: 352-522-0094 Fax: 352-522-0098 |