MEDICARE: MEDICAL CLINIC PA

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	261QP2300X	Primary Care Clinic/Center	19488	FL

General Provider Information

NPI Number	:	1871936815
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL CLINIC PA

Provider Business Mailing Address
First Line	:	1111 HYPOLUXO RD
Second Line	:	SUITE 107
City	:	LANTANA
State	:	FL
Zip	:	33462-4271
Country	:	US
Telephone Number	:	561-586-3400
Fax Number	:	561-585-0079

Provider Business Practice Location Address
First Line	:	1111 HYPOLUXO RD
Second Line	:	SUITE 107
City	:	LANTANA
State	:	FL
Zip	:	33462-4271
Country	:	US
Telephone Number	:	561-586-3400
Fax Number	:	561-585-0079

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEPHEN LOUIS NEMEROFSKY
Credential	:	M.D.
Telephone Number	:	561-586-3400

Provider Enumeration Date	:	04/09/2013
Last Update Date	:	04/09/2013

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Directions to “MEDICAL CLINIC PA ” Practice Location

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