Jupiter Lakes Physician Group Pa | |
210 Jupiter Lakes Blvd Ste 4104 Jupiter FL 33458-7190 | |
(561) 744-3467 | |
(561) 748-3272 |
Full Name | Jupiter Lakes Physician Group Pa |
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Speciality | Clinic/Center |
Location | 210 Jupiter Lakes Blvd Ste 4104, Jupiter, Florida |
Authorized Official Name and Position | Michelle Fuller (ADMINISTRATOR) |
Authorized Official Contact | 5613983661 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Jupiter Lakes Physician Group Pa 210 Jupiter Lakes Blvd Ste 4104 Jupiter FL 33458-7190 Ph: (561) 744-3467 | Jupiter Lakes Physician Group Pa 210 Jupiter Lakes Blvd Ste 4104 Jupiter FL 33458-7190 Ph: (561) 744-3467 |
NPI Number | 1154969699 |
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Provider Enumeration Date | 12/16/2019 |
Last Update Date | 12/16/2019 |
Medicare PECOS PAC ID | 7810326980 |
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Medicare Enrollment ID | O20200413000205 |
Identifier | Type | State | Issuer |
---|---|---|---|
1154969699 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
Provider Name | Baqir M Syed |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1881678464 PECOS PAC ID: 7719870500 Enrollment ID: I20050224000268 |
Provider Name | Jose J Stable |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1851346605 PECOS PAC ID: 5597851485 Enrollment ID: I20071024000174 |
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