Provider Demographics
NPI:1730485343
Name:TRILLIUM MEDICAL CENTER PLLC
Entity Type:Organization
Organization Name:TRILLIUM MEDICAL CENTER PLLC
Other - Org Name:TRILLIUM MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SUSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:561-906-3238
Mailing Address - Street 1:7545 W BOYNTON BEACH BLVD
Mailing Address - Street 2:SUIT 201
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-6166
Mailing Address - Country:US
Mailing Address - Phone:561-736-0881
Mailing Address - Fax:561-736-0887
Practice Address - Street 1:7545 W BOYNTON BEACH BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-6166
Practice Address - Country:US
Practice Address - Phone:561-906-3238
Practice Address - Fax:561-582-5204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-28
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10321207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty