Provider Demographics
NPI:1083995336
Name:MEDICAL PLAZA MANAGEMENT, INC.
Entity Type:Organization
Organization Name:MEDICAL PLAZA MANAGEMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BLAIR
Authorized Official - Middle Name:N
Authorized Official - Last Name:RETCHIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-756-9977
Mailing Address - Street 1:5385 NE 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-2707
Mailing Address - Country:US
Mailing Address - Phone:305-756-9977
Mailing Address - Fax:305-756-5757
Practice Address - Street 1:5385 NE 2ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-2707
Practice Address - Country:US
Practice Address - Phone:305-756-9977
Practice Address - Fax:305-756-5757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty