Provider Demographics
NPI:1053625988
Name:ADVANCE MEDICAL WEIGHT LOSS AND WELLNESS MEDICINE,
Entity type:Organization
Organization Name:ADVANCE MEDICAL WEIGHT LOSS AND WELLNESS MEDICINE,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FADEJIMI
Authorized Official - Middle Name:
Authorized Official - Last Name:ADELAKUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-989-1615
Mailing Address - Street 1:7601 N FEDERAL HWY
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-1657
Mailing Address - Country:US
Mailing Address - Phone:561-989-1615
Mailing Address - Fax:561-989-1618
Practice Address - Street 1:7601 N FEDERAL HWY
Practice Address - Street 2:SUITE 100A
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-1657
Practice Address - Country:US
Practice Address - Phone:561-989-1615
Practice Address - Fax:561-989-1618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME101158261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care