Provider Demographics
NPI:1407508930
Name:100 PHYSICIANS MEDICINE, LLC
Entity Type:Organization
Organization Name:100 PHYSICIANS MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:DE PUIGDORFILA
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:505-900-1476
Mailing Address - Street 1:17495 SE 74TH RAES HALL AVE
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-5352
Mailing Address - Country:US
Mailing Address - Phone:505-900-1476
Mailing Address - Fax:
Practice Address - Street 1:13721 N US HIGHWAY 441 STE 2
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-8910
Practice Address - Country:US
Practice Address - Phone:352-254-5544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty