Provider Demographics
NPI:1164818829
Name:COMPLEMED, LLC
Entity Type:Organization
Organization Name:COMPLEMED, LLC
Other - Org Name:COMPLEMED, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:BIEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:813-388-6865
Mailing Address - Street 1:2718 WINDGUARD CIRCLE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544
Mailing Address - Country:US
Mailing Address - Phone:813-388-6865
Mailing Address - Fax:813-388-6866
Practice Address - Street 1:2718 WINDGUARD CIRCLE
Practice Address - Street 2:SUITE 102
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544
Practice Address - Country:US
Practice Address - Phone:813-388-6865
Practice Address - Fax:813-388-6866
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEPHANIE MARGARET BIEN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5723207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE66467Medicare UPIN