Provider Demographics
NPI:1003044785
Name:PLOTKOWSKI, MICHAEL JOSEPH (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:PLOTKOWSKI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24565 TOWN CENTER DR APT 8206
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-0817
Mailing Address - Country:US
Mailing Address - Phone:813-784-8456
Mailing Address - Fax:
Practice Address - Street 1:24565 TOWN CENTER DR
Practice Address - Street 2:APT 8206
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-1371
Practice Address - Country:US
Practice Address - Phone:813-784-8456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1087705363A00000X
CA51684363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant