Provider Demographics
NPI:1164235024
Name:RL2IMC, PLLC
Entity type:Organization
Organization Name:RL2IMC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:LAROCQUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-252-0069
Mailing Address - Street 1:584 NW UNIVERSITY BLVD STE 370
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2268
Mailing Address - Country:US
Mailing Address - Phone:586-252-0069
Mailing Address - Fax:
Practice Address - Street 1:584 NW UNIVERSITY BLVD STE 370
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-2268
Practice Address - Country:US
Practice Address - Phone:586-252-0069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty