Provider Demographics
NPI:1245423292
Name:PLANTATION MEDICAL CLINIC PA
Entity Type:Organization
Organization Name:PLANTATION MEDICAL CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:P
Authorized Official - Last Name:SIMEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-424-4401
Mailing Address - Street 1:100 NW 82ND AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1899
Mailing Address - Country:US
Mailing Address - Phone:954-424-4401
Mailing Address - Fax:954-424-7603
Practice Address - Street 1:100 NW 82ND AVE
Practice Address - Street 2:STE 206
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1899
Practice Address - Country:US
Practice Address - Phone:954-424-4401
Practice Address - Fax:954-424-7603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2008-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty