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General NPI Number Information
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NPI Number | 1285337865
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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 | 03/23/2023
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 411 OFFICE PLAZA DR
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City | TALLAHASSEE
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State | FL
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Zip | 32301-2756
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Country | US
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Telephone | 800-773-7066
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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 | 407-860-0283
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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 | 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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