=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568099851
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ZACK RAMILEVICH MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2020
-----------------------------------------------------
Last Update Date | 12/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 875 MEADOWS RD STE 323
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33486-2349
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-788-7545
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9960 NW 116TH WAY STE 13
-----------------------------------------------------
City | MEDLEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33178-1175
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-924-1311
-----------------------------------------------------
Fax | 786-924-1313
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | ME166860
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------