Provider Demographics
NPI:1780075523
Name:ANDRO MEDICAL GROUP
Entity type:Organization
Organization Name:ANDRO MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SOPHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-445-1015
Mailing Address - Street 1:5300 W ATLANTIC AVE
Mailing Address - Street 2:400
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-8165
Mailing Address - Country:US
Mailing Address - Phone:866-445-1015
Mailing Address - Fax:877-576-3875
Practice Address - Street 1:5300 W ATLANTIC AVE
Practice Address - Street 2:400
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-8165
Practice Address - Country:US
Practice Address - Phone:866-445-1015
Practice Address - Fax:877-576-3875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty