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General NPI Number Information
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NPI Number | 1497182059
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Entity Type | Organization
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Legal Business Name | PHYSICIANS PARTNERS GROUP, LLC
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Dates
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Enumeration Date | 09/27/2013
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Last Update Date | 09/27/2013
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Provider Practice Location Address
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Address Line | 5801 NW 151ST ST 105
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2437
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Country | US
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Telephone | 305-305-1718
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Fax |
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Provider Business Mailing Address
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Address Line | 5801 NW 151ST ST 105
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2437
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Country | US
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Telephone | 305-305-1718
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. JOEL LAGO
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Credential |
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Telephone | 305-305-1718
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | ANOTHER
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License Number State | FL
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