Healthcare Provider Details

I. General information

NPI: 1780075523
Provider Name (Legal Business Name): ANDRO MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2015
Last Update Date: 02/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 W ATLANTIC AVE 400
DELRAY BEACH FL
33484-8165
US

IV. Provider business mailing address

5300 W ATLANTIC AVE 400
DELRAY BEACH FL
33484-8165
US

V. Phone/Fax

Practice location:
  • Phone: 866-445-1015
  • Fax: 877-576-3875
Mailing address:
  • Phone: 866-445-1015
  • Fax: 877-576-3875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: MS. SOPHIA LEWIS
Title or Position: ADMINISTRATIVE DIRECTOR
Credential:
Phone: 866-445-1015