Individualized Medicine, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

INDIVIDUALIZED MEDICINE, LLC

Practice address

6100 Saint Johns Ave
Suite 4(D)
Palatka, FL 32177-3844

Phone

(386) 329-3939

Fax

(386) 329-8990

NPI assigned

Mar 19, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Larisa Malykh, MD

Title

Practice Owner/Physician

Phone

(386) 329-3939

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1300492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332720000000",
    "number": "1962701722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 100",
            "city": "ELKTON",
            "state": "FL",
            "postal_code": "320330100",
            "telephone_number": "386-329-3939",
            "fax_number": "386-329-8990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6100 SAINT JOHNS AVE",
            "address_2": "SUITE 4(D)",
            "city": "PALATKA",
            "state": "FL",
            "postal_code": "321773844",
            "telephone_number": "386-329-3939",
            "fax_number": "386-329-8990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIVIDUALIZED MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-19",
        "last_updated": "2012-03-26",
        "status": "A",
        "authorized_official_last_name": "MALYKH",
        "authorized_official_first_name": "LARISA",
        "authorized_official_title_or_position": "PRACTICE OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "386-329-3939",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Palatka, FL
• Providers in Palatka, FL by specialty
• Primary Care Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.