Provider Demographics
NPI:1265777262
Name:PULMONARY CC LLC
Entity type:Organization
Organization Name:PULMONARY CC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAMBURA
Authorized Official - Middle Name:N
Authorized Official - Last Name:MKONO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-777-5308
Mailing Address - Street 1:6615 W BOYNTON BEACH BLVD PMB 101
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-3536
Mailing Address - Country:US
Mailing Address - Phone:561-777-5308
Mailing Address - Fax:561-303-2131
Practice Address - Street 1:10075 S JOG RD
Practice Address - Street 2:311
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3535
Practice Address - Country:US
Practice Address - Phone:561-777-5308
Practice Address - Fax:561-303-2131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-01
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME110611207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007946700Medicaid
FLPTANGW820AMedicare PIN