Provider Demographics
NPI:1336843325
Name:INTERNAL MEDICINE CARE OF THE PALM BEACHES PA
Entity Type:Organization
Organization Name:INTERNAL MEDICINE CARE OF THE PALM BEACHES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PD
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:O
Authorized Official - Last Name:QUAYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-638-8615
Mailing Address - Street 1:3345 BURNS RD STE 202
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4305
Mailing Address - Country:US
Mailing Address - Phone:954-638-8615
Mailing Address - Fax:954-635-5513
Practice Address - Street 1:3345 BURNS RD STE 202
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4305
Practice Address - Country:US
Practice Address - Phone:954-638-8615
Practice Address - Fax:954-635-5513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME160461OtherMEDICAL LIC