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General NPI Number Information
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NPI Number | 1154098580
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Entity Type | Organization
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Legal Business Name | HEALTHY MD CLINICAL, LLC F/K/A INDEPENDENT MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 08/24/2021
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 4360 NORTHLAKE BLVD STE 115
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-6264
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Country | US
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Telephone | 772-678-8258
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Fax |
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Provider Business Mailing Address
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Address Line | 6119 LYONS RD
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City | COCONUT CREEK
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State | FL
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Zip | 33073-4740
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Country | US
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Telephone | 800-773-7066
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | STEVE VIXAMAR
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Credential |
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Telephone | 800-773-7066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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