Provider Demographics
NPI:1831803121
Name:INTREPID FAMILY MEDICINE PLLC
Entity type:Organization
Organization Name:INTREPID FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVEILLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-612-3200
Mailing Address - Street 1:1411 N FLAGLER DR STE 8200
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3413
Mailing Address - Country:US
Mailing Address - Phone:561-612-3200
Mailing Address - Fax:561-335-5424
Practice Address - Street 1:1411 N FLAGLER DR STE 8200
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3413
Practice Address - Country:US
Practice Address - Phone:561-612-3200
Practice Address - Fax:561-335-5424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care