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General NPI Number Information
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NPI Number | 1215092697
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Entity Type | Organization
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Legal Business Name | NORTHLAKE MEDICAL CENTER
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4300 NORTHLAKE BLVD
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-6254
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Country | US
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Telephone | 561-626-9190
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Fax | 561-626-7274
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Provider Business Mailing Address
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Address Line | 4300 NORTHLAKE BLVD
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-6254
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Country | US
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Telephone | 561-626-9190
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Fax | 561-626-7274
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT WILLIAM MACKLER
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Credential | M.D.
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Telephone | 561-626-9192
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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