Healthcare Provider Details

I. General information

NPI: 1245092444
Provider Name (Legal Business Name): IVES MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2024
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 NW CORPORATE BLVD STE 201
BOCA RATON FL
33431-7336
US

IV. Provider business mailing address

1031 IVES DAIRY RD STE 228
MIAMI FL
33179-2538
US

V. Phone/Fax

Practice location:
  • Phone: 305-910-2801
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: TAMMY CARPENTER
Title or Position: OFFICE MANAGER
Credential:
Phone: 305-910-2801