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General NPI Number Information
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NPI Number | 1770677346
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Entity Type | Organization
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Legal Business Name | HOLISITIC FAMILY MEDICINE LLC
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9325 GLADES ROAD SUITE #104
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City | BOCA RATON
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State | FL
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Zip | 33434
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Country | US
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Telephone | 561-620-7779
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Fax | 561-367-9509
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Provider Business Mailing Address
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Address Line | 9325 GLADES ROAD SUITE #104
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City | BOCA RATON
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State | FL
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Zip | 33434
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Country | US
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Telephone | 561-620-7779
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Fax | 561-367-9509
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Authorized Official
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Title or Position | OWNER
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Name | DR. KENNETH NOAH WOLINER
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Credential | M.D.
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Telephone | 561-620-7779
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ME80412
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License Number State | FL
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