Provider Demographics
NPI:1629087812
Name:APPLETREE MEDICAL
Entity Type:Organization
Organization Name:APPLETREE MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LARAMEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-581-3171
Mailing Address - Street 1:1180 PONCE DE LEON BLVD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-1014
Mailing Address - Country:US
Mailing Address - Phone:727-581-3171
Mailing Address - Fax:727-581-0871
Practice Address - Street 1:1180 PONCE DE LEON BLVD
Practice Address - Street 2:SUITE 401
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-1014
Practice Address - Country:US
Practice Address - Phone:727-581-3171
Practice Address - Fax:727-581-0871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69487174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL43536OtherBCBS
FL43536OtherBCBS
FL43536OtherBCBS
FLF59905Medicare UPIN
FLE0344ZMedicare ID - Type UnspecifiedPROVIDER