Provider Demographics
NPI:1477303055
Name:ID&WM LLC
Entity Type:Organization
Organization Name:ID&WM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRUKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-401-3883
Mailing Address - Street 1:10862 CRESCENDO CIR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498-4873
Mailing Address - Country:US
Mailing Address - Phone:912-401-3883
Mailing Address - Fax:
Practice Address - Street 1:1324 SE 17TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-1708
Practice Address - Country:US
Practice Address - Phone:754-777-1333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty