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General NPI Number Information
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NPI Number | 1801487053
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Entity Type | Organization
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Legal Business Name | INDEPENDENT MEDICAL GROUP, LLC.
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Dates
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Enumeration Date | 01/31/2021
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Last Update Date | 11/16/2021
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Provider Practice Location Address
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Address Line | 3880 COCONUT CREEK PKWY STE 100
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City | COCONUT CREEK
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State | FL
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Zip | 33066-1643
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Country | US
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Telephone | 407-314-7492
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Fax | 833-258-4230
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Provider Business Mailing Address
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Address Line | 3880 COCONUT CREEK PKWY STE 100
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City | COCONUT CREEK
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State | FL
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Zip | 33066-1643
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Country | US
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Telephone | 407-314-7492
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Fax | 833-258-4230
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Authorized Official
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Title or Position | CLINICAL OPERATIONS MANAGER
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Name | SONIA N TORRES
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Credential |
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Telephone | 407-505-6435
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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