Provider Demographics
NPI:1194265595
Name:MDVIP MEDICAL GROUP NC PLLC
Entity type:Organization
Organization Name:MDVIP MEDICAL GROUP NC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-982-4300
Mailing Address - Street 1:4950 COMMUNICATION AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-3307
Mailing Address - Country:US
Mailing Address - Phone:561-982-4300
Mailing Address - Fax:
Practice Address - Street 1:2301 REXWOODS DR
Practice Address - Street 2:SUITE 118
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-0156
Practice Address - Country:US
Practice Address - Phone:919-803-1417
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MDVIP MEDICAL GROUP HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-03
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty