Provider Demographics
NPI:1033460001
Name:BRADENTON ENDOCRINOLOGY, PA
Entity Type:Organization
Organization Name:BRADENTON ENDOCRINOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LILLIBET
Authorized Official - Middle Name:MATHEW
Authorized Official - Last Name:PLACHERIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-795-1915
Mailing Address - Street 1:1906 59TH ST W STE B
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-4639
Mailing Address - Country:US
Mailing Address - Phone:941-795-1915
Mailing Address - Fax:941-795-2715
Practice Address - Street 1:1906 59TH ST W STE B
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-4639
Practice Address - Country:US
Practice Address - Phone:941-795-1915
Practice Address - Fax:941-795-2715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-30
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63167261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E87876Medicare UPIN
FL25870Medicare PIN