Prestige Internal Medicine | |
1002 S Old Dixie Hwy Ste 204 Jupiter FL 33458-7202 | |
(561) 517-8678 | |
(561) 529-5082 |
Full Name | Prestige Internal Medicine |
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Speciality | Internal Medicine |
Location | 1002 S Old Dixie Hwy Ste 204, Jupiter, Florida |
Authorized Official Name and Position | Michal Wall (CEO) |
Authorized Official Contact | 5615178678 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Prestige Internal Medicine 1002 S Old Dixie Hwy Ste 204 Jupiter FL 33458-7202 Ph: (561) 517-8678 | Prestige Internal Medicine 1002 S Old Dixie Hwy Ste 204 Jupiter FL 33458-7202 Ph: (561) 517-8678 |
NPI Number | 1710574413 |
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Provider Enumeration Date | 12/29/2020 |
Last Update Date | 04/16/2024 |
Medicare PECOS PAC ID | 1951710086 |
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Medicare Enrollment ID | O20210503000307 |
Identifier | Type | State | Issuer |
---|---|---|---|
1710574413 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (* (Not Available)) | Primary |
Provider Name | Michal S Wall |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1871701706 PECOS PAC ID: 2668633447 Enrollment ID: I20120423000546 |
Provider Name | Itamar Wall |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1982243630 PECOS PAC ID: 2264831544 Enrollment ID: I20210519002231 |
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