MEDICARE: INFINITY HEALTHCARE PORT SAINT LUCIE 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	207R00000X	Internal Medicine Physician
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1417785775
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INFINITY HEALTHCARE PORT SAINT LUCIE LLC

Provider Business Mailing Address
First Line	:	8890 W OAKLAND PARK BLVD STE 200
Second Line	:
City	:	SUNRISE
State	:	FL
Zip	:	33351-7221
Country	:	US
Telephone Number	:	954-741-3304
Fax Number	:	754-222-6417

Provider Business Practice Location Address
First Line	:	1226 SE PORT ST LUCIE BLVD
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-5364
Country	:	US
Telephone Number	:	772-666-1801
Fax Number	:	754-222-6417

Authorized Official
Title or Position	:	CEO
Name	:	JOSEPH DI CAPUA
Credential	:
Telephone Number	:	561-843-7720

Provider Enumeration Date	:	07/26/2024
Last Update Date	:	07/26/2024

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