Provider Demographics
NPI:1750723045
Name:INTERNAL MEDICINE OF PALM BEACH LLC
Entity type:Organization
Organization Name:INTERNAL MEDICINE OF PALM BEACH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:YAQUB
Authorized Official - Last Name:M
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-283-0381
Mailing Address - Street 1:3347 STATE ROAD 7
Mailing Address - Street 2:SUITE 206
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33449-8095
Mailing Address - Country:US
Mailing Address - Phone:561-283-0381
Mailing Address - Fax:561-434-3169
Practice Address - Street 1:3347 STATE ROAD 7
Practice Address - Street 2:SUITE 206
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33449-8095
Practice Address - Country:US
Practice Address - Phone:561-283-0381
Practice Address - Fax:561-434-3169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-27
Last Update Date:2013-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99808207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL280882000Medicaid
FL280882000Medicaid