Provider Demographics
NPI:1598134249
Name:PHYSICIANS PARTNERS GROUP II, LLC
Entity Type:Organization
Organization Name:PHYSICIANS PARTNERS GROUP II, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-305-1718
Mailing Address - Street 1:8004 NW 154TH ST # 208
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5814
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8004 NW 154TH ST # 208
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-5814
Practice Address - Country:US
Practice Address - Phone:305-305-1718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHYSICIANS PARTNERS GROUP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLANOTHER305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service