Healthcare Provider Details

I. General information

NPI: 1578194452
Provider Name (Legal Business Name): PROGRESSIVE CARE MEDICAL GROUP OF FL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 DEL PRADO CIR S
BOCA RATON FL
33433-3386
US

IV. Provider business mailing address

PO BOX 1040
SYOSSET NY
11791-0010
US

V. Phone/Fax

Practice location:
  • Phone: 800-860-3274
  • Fax: 888-910-1059
Mailing address:
  • Phone: 800-860-3274
  • Fax: 888-910-1059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ABIOLA FAMILUSI
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 516-729-8606