Provider Demographics
NPI:1114046372
Name:STAN ZEMANKIEWICZ M D PH D P A
Entity Type:Organization
Organization Name:STAN ZEMANKIEWICZ M D PH D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLUKIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-659-2502
Mailing Address - Street 1:2250 OSPREY BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-4340
Mailing Address - Country:US
Mailing Address - Phone:863-533-4033
Mailing Address - Fax:
Practice Address - Street 1:2250 OSPREY BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-4340
Practice Address - Country:US
Practice Address - Phone:863-533-4033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0047215207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL01454Medicare ID - Type Unspecified
FLE34368Medicare UPIN