Provider Demographics
NPI:1033099627
Name:CENTRUM MEDICAL GROUP PLLC
Entity type:Organization
Organization Name:CENTRUM MEDICAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-348-5570
Mailing Address - Street 1:9250 NW 36TH ST STE 420
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2775
Mailing Address - Country:US
Mailing Address - Phone:305-266-2929
Mailing Address - Fax:
Practice Address - Street 1:4903 N MCCOLL RD UNIT D
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2310
Practice Address - Country:US
Practice Address - Phone:305-266-2929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-04
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty