Basic Information
| Provider Information | |||||||||
| NPI: | 1265614713 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AGUIRRE INTERNAL MEDICINE GROUP OF THE PALM BEACHES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4960 SW 72ND AVE | ||||||||
| Address2: | SUITE 406 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331555544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056625200 | ||||||||
| FaxNumber: | 3052847948 | ||||||||
| Practice Location | |||||||||
| Address1: | 6215 S DIXIE HWY | ||||||||
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| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334054327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5615821201 | ||||||||
| FaxNumber: | 5615828076 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2007 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | CAMPO | ||||||||
| AuthorizedOfficialFirstName: | OTTO | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3056625200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.