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General NPI Number Information
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NPI Number | 1851475016
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Entity Type | Organization
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Legal Business Name | PALM SPRINGS INTERNAL MEDICINE
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 12/18/2012
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Provider Practice Location Address
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Address Line | 5053 S CONGRESS AVE SUITE 202
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City | LAKE WORTH
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State | FL
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Zip | 33461-4706
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Country | US
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Telephone | 561-439-4480
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Fax | 561-641-6626
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Provider Business Mailing Address
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Address Line | 5053 S CONGRESS AVE SUITE 202
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City | LAKE WORTH
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State | FL
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Zip | 33461-4706
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Country | US
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Telephone | 561-439-4480
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Fax | 561-641-6626
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. JUANITA BERMAN
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Credential |
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Telephone | 561-439-4480
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME47911
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License Number State | FL
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