Provider Demographics
NPI:1043643588
Name:CONCIERGE MEDICAL GROUP SOUTH FLORIDA LLC
Entity Type:Organization
Organization Name:CONCIERGE MEDICAL GROUP SOUTH FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ELROY
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:KALME LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:786-531-6800
Mailing Address - Street 1:10300 SW 72ND ST.
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165
Mailing Address - Country:US
Mailing Address - Phone:305-731-4064
Mailing Address - Fax:
Practice Address - Street 1:10300 SW 72ND ST.
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165
Practice Address - Country:US
Practice Address - Phone:305-731-4064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty