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General NPI Number Information
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NPI Number | 1730485343
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Entity Type | Organization
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Legal Business Name | TRILLIUM MEDICAL CENTER PLLC
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Dates
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Enumeration Date | 01/28/2011
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Last Update Date | 09/22/2011
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Provider Practice Location Address
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Address Line | 7545 W BOYNTON BEACH BLVD SUITE 201
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City | BOYNTON BEACH
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State | FL
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Zip | 33437-6166
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Country | US
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Telephone | 561-906-3238
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Fax | 561-582-5204
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Provider Business Mailing Address
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Address Line | 7545 W BOYNTON BEACH BLVD SUIT 201
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City | BOYNTON BEACH
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State | FL
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Zip | 33437-6166
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Country | US
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Telephone | 561-736-0881
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Fax | 561-736-0887
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KIMBERLY ANN SUSSMAN
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Credential | D.O.
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Telephone | 561-906-3238
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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 | OS10321
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License Number State | FL
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