MEDICARE: MAKSIM KLIMOVICH ARNP

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	363LA2200X	Adult Health Nurse Practitioner	ARNP9315517	FL

General Provider Information

NPI Number	:	1316489420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAKSIM KLIMOVICH ARNP

Provider Business Mailing Address
First Line	:	4915 S CONGRESS AVE STE A
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-4734
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4915 S CONGRESS AVE STE A
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-4734
Country	:	US
Telephone Number	:	561-967-1046
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2016
Last Update Date	:	11/07/2016

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