Healthcare Provider Details

I. General information

NPI: 1083683411
Provider Name (Legal Business Name): MEDICAL IPA OF THE PALM BEACHES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 ROYAL PALM BEACH BLVD SUITE 102
ROYAL PALM BEACH FL
33411-1641
US

IV. Provider business mailing address

1117 ROYAL PALM BEACH BLVD SUITE 102
ROYAL PALM BEACH FL
33411-1641
US

V. Phone/Fax

Practice location:
  • Phone: 561-790-2876
  • Fax: 561-790-3884
Mailing address:
  • Phone: 561-790-2876
  • Fax: 561-790-3884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT CAMERLINCK
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 561-790-2876