Provider Demographics
NPI:1982642898
Name:PLASENCIA FAMILY MEDICINE PLLC
Entity Type:Organization
Organization Name:PLASENCIA FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:PLASENCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-791-3401
Mailing Address - Street 1:4705 TOWNE CENTRE RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-2818
Mailing Address - Country:US
Mailing Address - Phone:989-791-3401
Mailing Address - Fax:989-791-3466
Practice Address - Street 1:4705 TOWNE CTR
Practice Address - Street 2:SUITE 202
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2818
Practice Address - Country:US
Practice Address - Phone:989-791-3401
Practice Address - Fax:989-791-3466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P20440Medicare PIN