Provider Demographics
NPI:1033392782
Name:FAMILY PRACTICE & INTERNAL MEDICINE OF THE PALM BEACHES LLC
Entity Type:Organization
Organization Name:FAMILY PRACTICE & INTERNAL MEDICINE OF THE PALM BEACHES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:LUCIBELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-776-8891
Mailing Address - Street 1:3401 PGA BLVD STE 430
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2825
Mailing Address - Country:US
Mailing Address - Phone:561-776-8891
Mailing Address - Fax:561-776-8503
Practice Address - Street 1:3401 PGA BLVD
Practice Address - Street 2:SUITE 430
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2825
Practice Address - Country:US
Practice Address - Phone:561-776-8891
Practice Address - Fax:561-776-8503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87728207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7382Medicare PIN