Provider Demographics
NPI:1770677346
Name:HOLISITIC FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:HOLISITIC FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:NOAH
Authorized Official - Last Name:WOLINER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-620-7779
Mailing Address - Street 1:9325 GLADES ROAD
Mailing Address - Street 2:SUITE #104
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434
Mailing Address - Country:US
Mailing Address - Phone:561-620-7779
Mailing Address - Fax:561-367-9509
Practice Address - Street 1:9325 GLADES ROAD
Practice Address - Street 2:SUITE #104
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434
Practice Address - Country:US
Practice Address - Phone:561-620-7779
Practice Address - Fax:561-367-9509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80412261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID#
FL=========OtherTAX ID#
FL35788XMedicare ID - Type UnspecifiedMEDICARE PROVIDER ID