Organization
PULMONOLOGY AND SLEEP CENTER LLC
Active
Organization
PULMONOLOGY AND SLEEP CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FREDERICK TACKEY MD (MANAGING MEMBER)
(561) 374-8919
Entity
Organization
Contact information
Practice address
2300 SOUTH CONGRESS AVENUE SUITE 101, BOYNTON BEACH, FL 33426
(561) 374-8911
(561) 374-8911
Mailing address
PO BOX 550, BOYNTON BEACH, FL 33425-0550
(561) 374-8919
(581) 374-8911
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
0068055
FL
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
0068055
FL
207RP1001X
Pulmonary Disease Physician
Primary
0068055
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
377890800
—
FL
Enumeration date
08/01/2006
Last updated
10/29/2012
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