Provider Demographics
NPI:1144271115
Name:IMA OF SOUTH FLORIDA LLC
Entity type:Organization
Organization Name:IMA OF SOUTH FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MEYER
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-997-8484
Mailing Address - Street 1:1601 CLINT MOORE RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-2768
Mailing Address - Country:US
Mailing Address - Phone:561-997-8484
Mailing Address - Fax:561-997-8429
Practice Address - Street 1:1601 CLINT MOORE RD
Practice Address - Street 2:SUITE 115
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-2768
Practice Address - Country:US
Practice Address - Phone:561-997-8484
Practice Address - Fax:561-997-8429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 70980207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45565Medicare ID - Type Unspecified
FL6385130001Medicare NSC