Provider Demographics
NPI:1366803322
Name:COCONUT CREEK PROFESSIONAL GROUP LLC
Entity type:Organization
Organization Name:COCONUT CREEK PROFESSIONAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:REUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-657-8524
Mailing Address - Street 1:3880 COCONUT CREEK PKWY STE 303
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33066-1651
Mailing Address - Country:US
Mailing Address - Phone:954-657-8524
Mailing Address - Fax:954-301-0794
Practice Address - Street 1:3880 COCONUT CREEK PKWY STE 303
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33066-1651
Practice Address - Country:US
Practice Address - Phone:954-657-8524
Practice Address - Fax:954-301-0794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Single Specialty