Provider Demographics
NPI:1114117587
Name:RADEMAKER PLASTIC SURGERY LLC
Entity Type:Organization
Organization Name:RADEMAKER PLASTIC SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BART
Authorized Official - Middle Name:
Authorized Official - Last Name:RADEMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-884-0160
Mailing Address - Street 1:11932 SHELDON ROAD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-3643
Mailing Address - Country:US
Mailing Address - Phone:813-884-0160
Mailing Address - Fax:813-885-9383
Practice Address - Street 1:11932 SHELDON ROAD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-3643
Practice Address - Country:US
Practice Address - Phone:813-884-0160
Practice Address - Fax:813-885-9383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty