MEDICARE: VETMED GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1114763521
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VETMED GROUP LLC

Provider Business Mailing Address
First Line	:	393 NE 5TH AVE UNIT B
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-5532
Country	:	US
Telephone Number	:	561-270-0003
Fax Number	:

Provider Business Practice Location Address
First Line	:	393 NE 5TH AVE UNIT B
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-5532
Country	:	US
Telephone Number	:	561-270-0003
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHAEL NIEMTZOW
Credential	:
Telephone Number	:	561-270-0003

Provider Enumeration Date	:	07/04/2024
Last Update Date	:	07/04/2024

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