Provider Demographics
NPI:1871332577
Name:MDMVILME
Entity type:Organization
Organization Name:MDMVILME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MADELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:VILME
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-428-6915
Mailing Address - Street 1:2894 NW TIMBERCREEK CIR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-4050
Mailing Address - Country:US
Mailing Address - Phone:602-428-6915
Mailing Address - Fax:
Practice Address - Street 1:2894 NW TIMBERCREEK CIR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-4050
Practice Address - Country:US
Practice Address - Phone:602-428-6915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-22
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty