MEDICARE: PRIME CARE VIP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1154162493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME CARE VIP LLC

Provider Business Mailing Address
First Line	:	990 S ROGERS CIR STE 4
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33487-2836
Country	:	US
Telephone Number	:	561-948-2020
Fax Number	:	561-785-0802

Provider Business Practice Location Address
First Line	:	990 S ROGERS CIR STE 4
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33487-2836
Country	:	US
Telephone Number	:	561-948-2020
Fax Number	:	561-785-0802

Authorized Official
Title or Position	:	CEO
Name	:	MR. MICHAEL LAWRENCE KIEFFER
Credential	:	APRN
Telephone Number	:	561-948-2020

Provider Enumeration Date	:	06/03/2024
Last Update Date	:	02/24/2026

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Directions to “PRIME CARE VIP LLC ” Practice Location

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