Provider Demographics
NPI:1457325011
Name:PALM BEACH PHYSICIANS GROUP INC
Entity type:Organization
Organization Name:PALM BEACH PHYSICIANS GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MINERVA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:561-840-4660
Mailing Address - Street 1:4601 N CONGRESS AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-3381
Mailing Address - Country:US
Mailing Address - Phone:561-840-4600
Mailing Address - Fax:561-840-4680
Practice Address - Street 1:4601 N CONGRESS AVE STE 200
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-3381
Practice Address - Country:US
Practice Address - Phone:561-840-4600
Practice Address - Fax:561-840-4680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-13
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME49828207R00000X, 207R00000X
FLME90839207R00000X, 207R00000X
FLOS11360207R00000X, 207R00000X
FLOS4532207R00000X
FLME46118207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3557OtherMEDICARE GROUP PTAN
FLK3557OtherMEDICARE GROUP PTAN