Provider Demographics
NPI:1639168800
Name:CAROL CITY MED PLUS INC
Entity Type:Organization
Organization Name:CAROL CITY MED PLUS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PIERRE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BLENIUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-625-9088
Mailing Address - Street 1:18373 NW 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAROL CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33056-3169
Mailing Address - Country:US
Mailing Address - Phone:305-625-9088
Mailing Address - Fax:305-625-0857
Practice Address - Street 1:18373 NW 27TH AVE
Practice Address - Street 2:
Practice Address - City:CAROL CITY
Practice Address - State:FL
Practice Address - Zip Code:33056-3169
Practice Address - Country:US
Practice Address - Phone:305-625-9088
Practice Address - Fax:305-625-0857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCCR2188207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K3776Medicare ID - Type Unspecified