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General NPI Number Information
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NPI Number | 1154162493
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Entity Type | Organization
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Legal Business Name | PRIME CARE VIP LLC
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Dates
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Enumeration Date | 06/03/2024
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Last Update Date | 02/24/2026
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Provider Practice Location Address
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Address Line | 990 S ROGERS CIR STE 4
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City | BOCA RATON
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State | FL
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Zip | 33487-2836
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Country | US
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Telephone | 561-948-2020
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Fax | 561-785-0802
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Provider Business Mailing Address
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Address Line | 990 S ROGERS CIR STE 4
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City | BOCA RATON
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State | FL
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Zip | 33487-2836
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Country | US
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Telephone | 561-948-2020
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Fax | 561-785-0802
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Authorized Official
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Title or Position | CEO
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Name | MR. MICHAEL LAWRENCE KIEFFER
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Credential | APRN
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Telephone | 561-948-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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