Provider Demographics
NPI:1063695708
Name:PALM BEACH INTERNAL MEDICINE
Entity type:Organization
Organization Name:PALM BEACH INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUPESH
Authorized Official - Middle Name:R
Authorized Official - Last Name:DHARIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-267-9311
Mailing Address - Street 1:3502 KYOTO GARDENS DR STE A
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2899
Mailing Address - Country:US
Mailing Address - Phone:561-776-8891
Mailing Address - Fax:866-436-2183
Practice Address - Street 1:3502 KYOTO GARDENS DR
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2984
Practice Address - Country:US
Practice Address - Phone:561-776-8891
Practice Address - Fax:866-436-2183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME082262207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7365Medicare PIN