Provider Demographics
NPI:1780058438
Name:PLATINUM HEALTHGROUP, INC.
Entity type:Organization
Organization Name:PLATINUM HEALTHGROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARQUES
Authorized Official - Middle Name:W
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-790-0667
Mailing Address - Street 1:17560 NW 27TH AVENUE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33056-4073
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17560 NW 27TH AVENUE
Practice Address - Street 2:SUITE 106
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33056-4073
Practice Address - Country:US
Practice Address - Phone:954-790-0667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty