Provider Demographics
NPI:1740590181
Name:MLEAC, INC
Entity Type:Organization
Organization Name:MLEAC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ENGROFF
Authorized Official - Suffix:
Authorized Official - Credentials:PT, PA-C
Authorized Official - Phone:561-346-9162
Mailing Address - Street 1:4774 S CLASSICAL BLVD
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-1225
Mailing Address - Country:US
Mailing Address - Phone:561-346-9162
Mailing Address - Fax:561-455-2696
Practice Address - Street 1:2580 METROCENTRE BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-3100
Practice Address - Country:US
Practice Address - Phone:561-684-2022
Practice Address - Fax:561-455-2696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7384174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY5555OtherBCBS
FLY5555OtherBCBS