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4601 N Congress Ave Ste 200 West Palm Beach FL 33407-3381 | |
| (561) 840-4600 | |
| (561) 840-4680 |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 4601 N Congress Ave Ste 200, West Palm Beach, Florida |
| Authorized Official Name and Position | Minerva Ellis (CHAIRMAN) |
| Authorized Official Contact | 5618404660 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
4601 N Congress Ave Ste 200 West Palm Beach FL 33407-3381 Ph: (561) 840-4600 | 4601 N Congress Ave Ste 200 West Palm Beach FL 33407-3381 Ph: (561) 840-4600 |
| NPI Number | 1457325011 |
|---|---|
| Provider Enumeration Date | 02/13/2006 |
| Last Update Date | 01/23/2025 |
| Medicare PECOS PAC ID | 0345218301 |
|---|---|
| Medicare Enrollment ID | O20040918000010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457325011 | NPI | - | NPPES |
| K3557 | Other | FL | MEDICARE GROUP PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | ME49828 (Florida) | Secondary |
| 207R00000X | Internal Medicine | ME90839 (Florida) | Secondary |
| 207R00000X | Internal Medicine | OS11360 (Florida) | Primary |
| Provider Name | Kenneth Sohn |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1013981646 PECOS PAC ID: 9638138258 Enrollment ID: I20041007000709 |
| Provider Name | Victor Molina |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1194798728 PECOS PAC ID: 4981672953 Enrollment ID: I20100303001013 |
| Provider Name | Jeffrey Dresner |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1164496543 PECOS PAC ID: 3072581040 Enrollment ID: I20100303001089 |
| Provider Name | Minerva M Ellis |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1457687691 PECOS PAC ID: 7113181694 Enrollment ID: I20120613000285 |
| Provider Name | Alexandra Marie Lacqua |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1598393852 PECOS PAC ID: 1052732526 Enrollment ID: I20230622000052 |
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