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General NPI Number Information
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NPI Number | 1245316165
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Entity Type | Organization
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Legal Business Name | MD4YOU LLC
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 440 N STATE ROAD 7 SUITE 101
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City | ROYAL PALM BEACH
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State | FL
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Zip | 33411-3504
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Country | US
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Telephone | 561-337-6944
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Fax | 561-337-6955
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Provider Business Mailing Address
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Address Line | PO BOX 211118
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City | ROYAL PALM BEACH
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State | FL
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Zip | 33421-1118
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN SOLE PROPRIETOR
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Name | DR. TODD WELLIVER
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Credential | M.D.
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Telephone | 561-667-8369
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME92061
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License Number State | FL
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