Provider Demographics
NPI:1477733327
Name:GEORGE R TERSHAKOVEC MD PA
Entity Type:Organization
Organization Name:GEORGE R TERSHAKOVEC MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:R
Authorized Official - Last Name:TERSHAKOVEC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-243-8701
Mailing Address - Street 1:975 BAPTIST WAY STE 201
Mailing Address - Street 2:HOMESTEAD HOSPITAL
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-7600
Mailing Address - Country:US
Mailing Address - Phone:786-243-8701
Mailing Address - Fax:786-243-8700
Practice Address - Street 1:975 BAPTIST WAY STE 201
Practice Address - Street 2:HOMESTEAD HOSPITAL
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-7600
Practice Address - Country:US
Practice Address - Phone:786-243-8701
Practice Address - Fax:786-243-8700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME039114208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34580OtherBCBS
FL34580OtherBCBS