| Innovative Diabetic Solutions Pllc | |
|
660 Glades Rd Ste 240 Boca Raton FL 33431-6466 | |
| (561) 368-2005 | |
| (561) 338-2178 |
| Full Name | Innovative Diabetic Solutions Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 660 Glades Rd Ste 240, Boca Raton, Florida |
| Authorized Official Name and Position | Richard Alexis Conlen (OWNER) |
| Authorized Official Contact | 5613682005 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Innovative Diabetic Solutions Pllc 4317 Intracoastal Drive Highland Beach FL 33487 Ph: (561) 715-2493 | Innovative Diabetic Solutions Pllc 660 Glades Rd Ste 240 Boca Raton FL 33431-6466 Ph: (561) 368-2005 |
| NPI Number | 1124712054 |
|---|---|
| Provider Enumeration Date | 06/05/2023 |
| Last Update Date | 07/26/2024 |
| Medicare PECOS PAC ID | 7214381839 |
|---|---|
| Medicare Enrollment ID | O20230929001338 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124712054 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Pauline M Cole |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376526202 PECOS PAC ID: 3274661079 Enrollment ID: I20111216000495 |
| Provider Name | Richard A Conlen |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1942260781 PECOS PAC ID: 5991867822 Enrollment ID: I20120117000444 |
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