Healthcare Provider Details

I. General information

NPI: 1972008944
Provider Name (Legal Business Name): MINH QUAN THANH LE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E SAMPLE RD FL 4
DEERFIELD BEACH FL
33064-3502
US

IV. Provider business mailing address

1 ROYAL PALM WAY PH 304
BOCA RATON FL
33432-8738
US

V. Phone/Fax

Practice location:
  • Phone: 954-786-6413
  • Fax:
Mailing address:
  • Phone: 954-673-9850
  • Fax: 561-955-3577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number01091053A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberME163937
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: