MEDICARE: WP BLUE HORIZON PSYCHIATRY 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	2084P0800X	Psychiatry Physician	ME123508	FL

General Provider Information

NPI Number	:	1609305598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WP BLUE HORIZON PSYCHIATRY LLC

Provider Business Mailing Address
First Line	:	2650 LAKE SHORE DR UNIT 502
Second Line	:
City	:	RIVIERA BEACH
State	:	FL
Zip	:	33404-4607
Country	:	US
Telephone Number	:	786-423-3028
Fax Number	:

Provider Business Practice Location Address
First Line	:	7721 N MILITARY TRL STE 1-2
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33410-7429
Country	:	US
Telephone Number	:	561-557-5052
Fax Number	:

Authorized Official
Title or Position	:	PSYCHIATRIST
Name	:	DR. WILLY PHILIAS
Credential	:	MD
Telephone Number	:	786-423-3028

Provider Enumeration Date	:	06/05/2017
Last Update Date	:	08/02/2021

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