Provider Demographics
NPI:1073559878
Name:MEDICAL OFFICE CONCEPTS
Entity Type:Organization
Organization Name:MEDICAL OFFICE CONCEPTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-736-8806
Mailing Address - Street 1:1501 CORPORATE DR # WAY-240
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-6600
Mailing Address - Country:US
Mailing Address - Phone:561-736-8806
Mailing Address - Fax:561-736-3384
Practice Address - Street 1:1501 CORPORATE DR # WAY-240
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-6600
Practice Address - Country:US
Practice Address - Phone:561-736-8806
Practice Address - Fax:561-736-3384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL61481OtherBLUECROSS BLUESHIELD
FLK0039Medicare PIN