Provider Demographics
NPI:1861845463
Name:MAXIM MEDICAL CENTER PA
Entity Type:Organization
Organization Name:MAXIM MEDICAL CENTER PA
Other - Org Name:MAXIM MEDICAL CENTER PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAXIM
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUMAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-623-2002
Mailing Address - Street 1:551 N FEDERAL HWY
Mailing Address - Street 2:SUITE 800
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2559
Mailing Address - Country:US
Mailing Address - Phone:832-623-2002
Mailing Address - Fax:
Practice Address - Street 1:551 N FEDERAL HWY
Practice Address - Street 2:SUITE 800
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2559
Practice Address - Country:US
Practice Address - Phone:832-623-2002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009449300Medicaid
FLH0263UMedicare UPIN