Provider Demographics
NPI:1942463054
Name:CHUMAK, MAXIM (MD)
Entity Type:Individual
Prefix:DR
First Name:MAXIM
Middle Name:
Last Name:CHUMAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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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:186-639-5218
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:186-639-5218
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301093152208600000X, 207Q00000X
FLME114939207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery