Provider Demographics
NPI:1699350371
Name:INFINITE MEDICAL GROUP, LLC
Entity type:Organization
Organization Name:INFINITE MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RONNY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:UPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-644-8880
Mailing Address - Street 1:20434 BEACHFIELD LN
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-3942
Mailing Address - Country:US
Mailing Address - Phone:209-270-2414
Mailing Address - Fax:
Practice Address - Street 1:2116 S DUPONT HWY STE 3
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:DE
Practice Address - Zip Code:19934-1259
Practice Address - Country:US
Practice Address - Phone:302-449-7484
Practice Address - Fax:302-327-4203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-14
Last Update Date:2021-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center