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General NPI Number Information
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NPI Number | 1356496137
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Entity Type | Organization
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Legal Business Name | ADVANCED INTERNAL MEDICINE LLC
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 06/20/2011
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Provider Practice Location Address
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Address Line | 601 UNIVERSITY BLVD SUITE 105
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City | JUPITER
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State | FL
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Zip | 33458
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Country | US
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Telephone | 561-625-9575
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Fax | 561-625-9533
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Provider Business Mailing Address
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Address Line | 601 UNIVERSITY BOULEVARD SUITE 105
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City | JUPITER
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State | FL
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Zip | 33458
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Country | US
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Telephone | 561-625-9575
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Fax | 561-625-9533
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Authorized Official
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Title or Position | OWNER
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Name | DR. SALUJA VARGHESE
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Credential | MD
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Telephone | 561-625-9575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 202K00000X
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Taxonomy Name | Phlebology Physician
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License Number | ME85291
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME86718
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License Number State | FL
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