=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003715467
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MULTISPECIALTYHEALTHCARE VIP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/03/2026
-----------------------------------------------------
Last Update Date | 11/03/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1881 N UNIVERSITY DR STE 110
-----------------------------------------------------
City | CORAL SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33071-6094
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-710-0107
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1881 N UNIVERSITY DR STE 110
-----------------------------------------------------
City | CORAL SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33071-6094
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-710-0107
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MICHAEL FUNK
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 954-609-7989
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------