Provider Demographics
NPI:1912899113
Name:OPTIMUM HEALTH MEDICAL GROUP, LLC.
Entity type:Organization
Organization Name:OPTIMUM HEALTH MEDICAL GROUP, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:OPTIMUM HEALTH
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDICAL GROUP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-705-7978
Mailing Address - Street 1:14280 S MILITARY TRL UNIT 6902
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-2628
Mailing Address - Country:US
Mailing Address - Phone:561-705-7978
Mailing Address - Fax:
Practice Address - Street 1:11082 S MILITARY TRL STE B46
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-7217
Practice Address - Country:US
Practice Address - Phone:561-705-7978
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-21
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty