Healthcare Provider Details

I. General information

NPI: 1588095442
Provider Name (Legal Business Name): MDLIVE MEDICAL GROUP OR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2013
Last Update Date: 12/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13630 NW 8TH ST STE 205
SUNRISE FL
33325-6238
US

IV. Provider business mailing address

4350 FOWLER ST STE 21
FORT MYERS FL
33901-2616
US

V. Phone/Fax

Practice location:
  • Phone: 855-332-4499
  • Fax: 231-932-4133
Mailing address:
  • Phone: 855-332-4499
  • Fax: 231-932-4133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEVE MOTARJEME
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 855-332-4499