Provider Demographics
NPI:1205242047
Name:DETOX SOLUTIONS OF THE PALM BEACHES
Entity type:Organization
Organization Name:DETOX SOLUTIONS OF THE PALM BEACHES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:LIPORACE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:561-491-4171
Mailing Address - Street 1:580 VILLAGE BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-1904
Mailing Address - Country:US
Mailing Address - Phone:561-491-4171
Mailing Address - Fax:561-688-9565
Practice Address - Street 1:580 VILLAGE BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-1904
Practice Address - Country:US
Practice Address - Phone:561-491-4171
Practice Address - Fax:561-688-9565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5607207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty