Provider Demographics
NPI:1457500720
Name:PLANTATION MEDICAL CLINIC
Entity Type:Organization
Organization Name:PLANTATION MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-424-7504
Mailing Address - Street 1:100 NW 82ND AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-7809
Mailing Address - Country:US
Mailing Address - Phone:954-424-7504
Mailing Address - Fax:954-424-7603
Practice Address - Street 1:100 NW 82ND AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-7809
Practice Address - Country:US
Practice Address - Phone:954-424-7504
Practice Address - Fax:954-424-7603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0044831207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0063Medicare PIN