MEDICARE: PALM MEDICAL OF SOUTH FLORIDA

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	207R00000X	Internal Medicine Physician	OS7340	FL

General Provider Information

NPI Number	:	1215226170
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALM MEDICAL OF SOUTH FLORIDA

Provider Business Mailing Address
First Line	:	200 KNUTH RD
Second Line	:	SUITE 150
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33436-4629
Country	:	US
Telephone Number	:	561-364-5600
Fax Number	:	561-364-4010

Provider Business Practice Location Address
First Line	:	200 KNUTH RD
Second Line	:	SUITE 150
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33436-4629
Country	:	US
Telephone Number	:	561-364-5600
Fax Number	:	561-364-4010

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STUART T LEWIS
Credential	:	DO
Telephone Number	:	561-364-5600

Provider Enumeration Date	:	03/31/2011
Last Update Date	:	03/31/2011

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