| Legacy Medical Pllc | |
|
11380 Prosperity Farms Rd Ste 114 Palm Beach Gardens FL 33410-3464 | |
| (917) 209-9990 | |
| Not Available |
| Full Name | Legacy Medical Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 11380 Prosperity Farms Rd Ste 114, Palm Beach Gardens, Florida |
| Authorized Official Name and Position | Yana Shtern (AUTHORIZED MEMBER) |
| Authorized Official Contact | 9172099990 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Legacy Medical Pllc 11380 Prosperity Farms Rd Ste 114 Palm Beach Gardens FL 33410-3464 Ph: (917) 209-9990 | Legacy Medical Pllc 11380 Prosperity Farms Rd Ste 114 Palm Beach Gardens FL 33410-3464 Ph: (917) 209-9990 |
| NPI Number | 1609647866 |
|---|---|
| Provider Enumeration Date | 01/15/2024 |
| Last Update Date | 01/15/2024 |
| Medicare PECOS PAC ID | 3577909811 |
|---|---|
| Medicare Enrollment ID | O20240309000063 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609647866 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 207RN0300X | Internal Medicine - Nephrology | (* (Not Available)) | Primary |
| Provider Name | Yana Shtern |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1497940852 PECOS PAC ID: 3971763731 Enrollment ID: I20200317000045 |
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