Provider Demographics
NPI:1649655598
Name:VISUM MANAGEMENT, LLC
Entity type:Organization
Organization Name:VISUM MANAGEMENT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:K
Authorized Official - Last Name:GROTEKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-474-9729
Mailing Address - Street 1:3006 GULF TO BAY BLVD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-4313
Mailing Address - Country:US
Mailing Address - Phone:727-474-9729
Mailing Address - Fax:727-474-9947
Practice Address - Street 1:3006 GULF TO BAY BLVD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-4313
Practice Address - Country:US
Practice Address - Phone:727-474-9729
Practice Address - Fax:727-474-9947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty