Provider Demographics
NPI:1588682678
Name:LAMPERT, MITCHELL (MD)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:LAMPERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11195 S JOG RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-1829
Mailing Address - Country:US
Mailing Address - Phone:561-733-9690
Mailing Address - Fax:561-736-7191
Practice Address - Street 1:10075 JOG RD
Practice Address - Street 2:SUITE 301
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3535
Practice Address - Country:US
Practice Address - Phone:561-736-8600
Practice Address - Fax:561-736-7191
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 77639207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH28681Medicare UPIN
FL35296ZMedicare ID - Type Unspecified