Organization
ADVANCED BREAST CARE OF THE PALM BEACHES, PA.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KATHLEEN E MINNICK M.D. (OWNER)
(561) 798-7494
Entity
Organization
Contact information
Practice address
12160 S SHORE BLVD, SUITE 103, WELLINGTON, FL 33414-6269
(561) 798-7494
(978) 327-7952
Mailing address
125 S STATE ROAD 7, SUITE 104-363, WELLINGTON, FL 33414-4385
(561) 798-7494
(978) 327-7952
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
ME78137
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02-04-2010
UNITED
FL
01
—
03-01-2010
MEDICARE
FL
01
—
03-31-2005
BCBS
FL
01
—
04-01-2010
AETNA
FL
01
—
05-15-2010
GHI
FL
01
—
05-27-2010
CIGNA
FL
01
—
07-06-2005
AVMED
FL
Enumeration date
02/16/2010
Last updated
08/24/2010
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