Provider Demographics
NPI:1053856617
Name:MDVIP MEDICAL GROUP FL PLLC
Entity Type:Organization
Organization Name:MDVIP MEDICAL GROUP FL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEMES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:561-982-4300
Mailing Address - Street 1:4950 COMMUNICATION AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-3307
Mailing Address - Country:US
Mailing Address - Phone:561-982-4300
Mailing Address - Fax:561-953-6617
Practice Address - Street 1:1411 N FLAGLER DR
Practice Address - Street 2:SUITE 6200
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3404
Practice Address - Country:US
Practice Address - Phone:561-659-1238
Practice Address - Fax:561-953-6617
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MDVIP MEDICAL GROUP HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-05
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty