Provider Demographics
NPI:1174496418
Name:WAY CONCIERGE MEDICINE LLC
Entity type:Organization
Organization Name:WAY CONCIERGE MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:DE SOUZA E MELO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-970-1303
Mailing Address - Street 1:8131 LAKEWOOD MAIN ST STE 205
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-5060
Mailing Address - Country:US
Mailing Address - Phone:860-970-1303
Mailing Address - Fax:941-344-0621
Practice Address - Street 1:8131 LAKEWOOD MAIN ST STE 205
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-5060
Practice Address - Country:US
Practice Address - Phone:860-970-1303
Practice Address - Fax:941-344-0621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-24
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty