Basic Information
| Provider Information | |||||||||
| NPI: | 1528399276 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ACCORD MEDICAL GROUP,PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5112 N HABANA AVE | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336146873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8133742406 | ||||||||
| FaxNumber: | 8133742407 | ||||||||
| Practice Location | |||||||||
| Address1: | 5112 N HABANA AVE | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336146873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8133742406 | ||||||||
| FaxNumber: | 8133742407 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2010 | ||||||||
| LastUpdateDate: | 04/12/2018 | ||||||||
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| AuthorizedOfficialLastName: | ATIGRE | ||||||||
| AuthorizedOfficialFirstName: | PHILIP | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT AND CEO | ||||||||
| AuthorizedOfficialTelephone: | 8133404866 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | ME 104059 | FL | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
ID Information
| ID | Type | State | Issuer | Description | 006556300 | 05 | FL | MEDICAID |