Provider Demographics
NPI:1649009838
Name:LIVEWELL ENDOCRINOLOGY BOCA PLLC
Entity type:Organization
Organization Name:LIVEWELL ENDOCRINOLOGY BOCA PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:561-873-2171
Mailing Address - Street 1:1489 W PALMETTO PARK RD STE 410B
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-3325
Mailing Address - Country:US
Mailing Address - Phone:561-873-2171
Mailing Address - Fax:
Practice Address - Street 1:1489 W PALMETTO PARK RD STE 410B
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-3325
Practice Address - Country:US
Practice Address - Phone:561-872-2171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-29
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric EndocrinologyGroup - Multi-Specialty