Provider Demographics
NPI:1821496597
Name:TRICOUNTY MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:TRICOUNTY MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHID
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARIF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-637-2898
Mailing Address - Street 1:1906 WINGFIELD DR
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-7007
Mailing Address - Country:US
Mailing Address - Phone:407-637-2898
Mailing Address - Fax:
Practice Address - Street 1:1906 WINGFIELD DR
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-7007
Practice Address - Country:US
Practice Address - Phone:407-637-2898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-12
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92280207R00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty