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General NPI Number Information
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NPI Number | 1083900781
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Entity Type | Organization
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Legal Business Name | PICADILLY MEDICAL LLC
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Dates
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Enumeration Date | 06/22/2011
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Last Update Date | 06/25/2013
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Provider Practice Location Address
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Address Line | 222 PICADILLY ST SUITE 101
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City | WEST PALM BEACH
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State | FL
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Zip | 33407-6017
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Country | US
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Telephone | 772-323-2099
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Fax |
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Provider Business Mailing Address
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Address Line | 5220 HOOD RD SUITE 101
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33418-8910
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Country | US
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Telephone | 561-748-2889
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Fax | 561-748-2889
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Authorized Official
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Title or Position | PRESIDENT, JUPITER PROF. DEVELOPMEN
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Name | KAREN BARLOW
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Credential |
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Telephone | 561-748-2889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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