MEDICARE: MAXIM MEDICAL CENTER PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0122X	Plastic and Reconstructive Surgery Physician
2	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861845463
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAXIM MEDICAL CENTER PA

Provider Business Mailing Address
First Line	:	551 N FEDERAL HWY
Second Line	:	SUITE 800
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2559
Country	:	US
Telephone Number	:	832-623-2002
Fax Number	:

Provider Business Practice Location Address
First Line	:	551 N FEDERAL HWY
Second Line	:	SUITE 800
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2559
Country	:	US
Telephone Number	:	832-623-2002
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/ OWNER
Name	:	DR. MAXIM CHUMAK
Credential	:	MD
Telephone Number	:	832-623-2002

Provider Enumeration Date	:	07/19/2016
Last Update Date	:	07/19/2016

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Directions to “MAXIM MEDICAL CENTER PA ” Practice Location

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