Healthcare Provider Details

I. General information

NPI: 1649009838
Provider Name (Legal Business Name): LIVEWELL ENDOCRINOLOGY BOCA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1489 W PALMETTO PARK RD STE 410B
BOCA RATON FL
33486-3325
US

IV. Provider business mailing address

1489 W PALMETTO PARK RD STE 410B
BOCA RATON FL
33486-3325
US

V. Phone/Fax

Practice location:
  • Phone: 561-872-2171
  • Fax:
Mailing address:
  • Phone: 561-873-2171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: HARA BERGER
Title or Position: OWNER
Credential: DO
Phone: 561-873-2171