Provider Demographics
NPI:1083707202
Name:COCONUT CREEK PHYSICIANS P L
Entity Type:Organization
Organization Name:COCONUT CREEK PHYSICIANS P L
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:ANGELILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-973-9666
Mailing Address - Street 1:3880 COCONUT CREEK PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33066-1652
Mailing Address - Country:US
Mailing Address - Phone:954-973-9666
Mailing Address - Fax:954-978-6625
Practice Address - Street 1:3880 COCONUT CREEK PKWY STE 100
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33066-1652
Practice Address - Country:US
Practice Address - Phone:954-973-9666
Practice Address - Fax:954-978-6625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1356Medicare PIN