Provider Demographics
NPI:1417307331
Name:ADREA R. SAMOLESKI, MD PA
Entity Type:Organization
Organization Name:ADREA R. SAMOLESKI, MD PA
Other - Org Name:WEST BOCA FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADREA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:SAMOLESKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-850-9124
Mailing Address - Street 1:9563 LAKE SERENA DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-6516
Mailing Address - Country:US
Mailing Address - Phone:561-850-9124
Mailing Address - Fax:404-666-5100
Practice Address - Street 1:7100 W CAMINO REAL
Practice Address - Street 2:SUITE 121
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-5510
Practice Address - Country:US
Practice Address - Phone:561-850-9124
Practice Address - Fax:404-666-5100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95765207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME95765OtherMEDICAL LICENSE