Healthcare Provider Details

I. General information

NPI: 1154098580
Provider Name (Legal Business Name): HEALTHY MD CLINICAL, LLC F/K/A INDEPENDENT MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4360 NORTHLAKE BLVD STE 115
PALM BEACH GARDENS FL
33410-6264
US

IV. Provider business mailing address

6119 LYONS RD
COCONUT CREEK FL
33073-4740
US

V. Phone/Fax

Practice location:
  • Phone: 772-678-8258
  • Fax:
Mailing address:
  • Phone: 800-773-7066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEVE VIXAMAR
Title or Position: CEO
Credential:
Phone: 800-773-7066