| Jupiter Lakes Physician Group Pa | |
|
210 Jupiter Lakes Blvd Ste 4104 Jupiter FL 33458-7190 | |
| (561) 744-3467 | |
| (561) 748-3272 |
| Full Name | Jupiter Lakes Physician Group Pa |
|---|---|
| Speciality | Clinic/Center |
| Location | 210 Jupiter Lakes Blvd Ste 4104, Jupiter, Florida |
| Authorized Official Name and Position | Michelle Fuller (ADMINISTRATOR) |
| Authorized Official Contact | 5613983661 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jupiter Lakes Physician Group Pa 210 Jupiter Lakes Blvd Ste 4104 Jupiter FL 33458-7190 Ph: (561) 744-3467 | Jupiter Lakes Physician Group Pa 210 Jupiter Lakes Blvd Ste 4104 Jupiter FL 33458-7190 Ph: (561) 744-3467 |
| NPI Number | 1154969699 |
|---|---|
| Provider Enumeration Date | 12/16/2019 |
| Last Update Date | 12/16/2019 |
| Medicare PECOS PAC ID | 7810326980 |
|---|---|
| Medicare Enrollment ID | O20200413000205 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154969699 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Baqir M Syed |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1881678464 PECOS PAC ID: 7719870500 Enrollment ID: I20050224000268 |
| Provider Name | Jose J Stable |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851346605 PECOS PAC ID: 5597851485 Enrollment ID: I20071024000174 |
| Provider Name | Leslie E Diaz |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1750342689 PECOS PAC ID: 3375506165 Enrollment ID: I20091015000342 |
| Provider Name | Lorraine R Marshall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962884874 PECOS PAC ID: 1456616960 Enrollment ID: I20180605001146 |
| Provider Name | Claudia Salgado Lugo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467209262 PECOS PAC ID: 7719404425 Enrollment ID: I20250506003444 |
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