Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Burnt Store Family Medicine P L

Organization Family Medicine Physician · NPI 1164739421

Burnt Store Family Medicine P L is a Family Medicine Physician in Punta Gorda, Florida. Licensed in Florida. Registered with an NPI since 2010.

Licensed in
FL
In the registry since
2010

Practice location Address checks out

100 Madrid Blvd Ste 513
Punta Gorda, FL 33950-7968
Phone: (941) 505-0974
Fax: (941) 505-8517
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence ME0072508 (FL)

Record details

NPI number1164739421
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Gordon Wang — Owner · (941) 505-0974
NPI enumeratedSeptember 8, 2010
Last updated in NPPESJune 23, 2011
Mailing address100 Madrid Blvd, Suite 513, Punta Gorda, FL 33950-7968

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