Healthcare Provider Details

I. General information

NPI: 1073011128
Provider Name (Legal Business Name): ISLAND MEDICAL CONSULTING OF VI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2018
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

733 US HIGHWAY 1
NORTH PALM BEACH FL
33408-4513
US

IV. Provider business mailing address

11 PALM POINT DR
JUPITER FL
33458-4029
US

V. Phone/Fax

Practice location:
  • Phone: 561-840-1090
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberME75010
License Number StateFL

VIII. Authorized Official

Name: ALEXANDER LENARD
Title or Position: OWNER/MANAGER
Credential: MD
Phone: 561-840-1090