Healthcare Provider Details

I. General information

NPI: 1699350371
Provider Name (Legal Business Name): INFINITE MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2021
Last Update Date: 03/14/2021
Certification Date: 03/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2116 S DUPONT HWY STE 3
CAMDEN DE
19934-1259
US

IV. Provider business mailing address

20434 BEACHFIELD LN
MILFORD DE
19963-3942
US

V. Phone/Fax

Practice location:
  • Phone: 302-449-7484
  • Fax: 302-327-4203
Mailing address:
  • Phone: 209-270-2414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RONNY LEE UPP
Title or Position: PRESIDENT
Credential:
Phone: 302-644-8880