Provider Demographics
NPI:1295721389
Name:SOUTH PALM GI PA
Entity type:Organization
Organization Name:SOUTH PALM GI PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:BLUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-495-5700
Mailing Address - Street 1:4675 LINTON BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-6611
Mailing Address - Country:US
Mailing Address - Phone:561-495-5700
Mailing Address - Fax:561-495-2020
Practice Address - Street 1:4675 LINTON BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-6611
Practice Address - Country:US
Practice Address - Phone:561-495-5700
Practice Address - Fax:561-495-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0827Medicare ID - Type Unspecified