Basic Information
| Provider Information | |||||||||
| NPI: | 1417623489 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMICUS MEDICAL CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1300 CONCORD TER STE 210 | ||||||||
| Address2: | |||||||||
| City: | SUNRISE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333232899 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545055000 | ||||||||
| FaxNumber: | 9548389660 | ||||||||
| Practice Location | |||||||||
| Address1: | 1601 S CONGRESS AVE # B | ||||||||
| Address2: | |||||||||
| City: | DELRAY BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334456368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5612768444 | ||||||||
| FaxNumber: | 5612768805 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2021 | ||||||||
| LastUpdateDate: | 10/08/2021 | ||||||||
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| AuthorizedOfficialLastName: | ECHEVARRIA | ||||||||
| AuthorizedOfficialFirstName: | HERIKA | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 9545055000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | N | 193200000X MULTI-SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.