Basic Information
| Provider Information | |||||||||
| NPI: | 1942519277 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BOYNTON MEDICAL GROUP INC | ||||||||
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| OtherOrganizationName: | AMICUS MEDICAL GROUP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14201 W SUNRISE BLVD | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | SUNRISE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333233207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545055000 | ||||||||
| FaxNumber: | 9548389660 | ||||||||
| Practice Location | |||||||||
| Address1: | 1501 CORPORATE DR | ||||||||
| Address2: | |||||||||
| City: | BOYNTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334266600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613694255 | ||||||||
| FaxNumber: | 5613693254 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2010 | ||||||||
| LastUpdateDate: | 04/01/2015 | ||||||||
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| AuthorizedOfficialLastName: | RODRIGUEZ | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9545055000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME91277 | FL | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.