Provider Demographics
NPI:1255679031
Name:ANTHEM MEDICAL MANAGEMENT INC
Entity Type:Organization
Organization Name:ANTHEM MEDICAL MANAGEMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOISE
Authorized Official - Middle Name:W
Authorized Official - Last Name:ANGLADE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-629-7267
Mailing Address - Street 1:1483 S FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-6003
Mailing Address - Country:US
Mailing Address - Phone:561-629-7267
Mailing Address - Fax:561-629-7954
Practice Address - Street 1:1483 S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-6003
Practice Address - Country:US
Practice Address - Phone:561-629-7267
Practice Address - Fax:561-629-7954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization