Basic Information
| Provider Information | |||||||||
| NPI: | 1215311196 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NAGSUK | ||||||||
| FirstName: | PHILLIPS | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6041 SW 54TH ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344745521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3528578417 | ||||||||
| FaxNumber: | 3528772183 | ||||||||
| Practice Location | |||||||||
| Address1: | 6041 SW 54TH ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344745521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3528578417 | ||||||||
| FaxNumber: | 3528772183 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2015 | ||||||||
| LastUpdateDate: | 05/04/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | ME130544 | FL | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.