Healthcare Provider Details

I. General information

NPI: 1083995336
Provider Name (Legal Business Name): MEDICAL PLAZA MANAGEMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2011
Last Update Date: 08/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5385 NE 2ND AVE
MIAMI FL
33137-2707
US

IV. Provider business mailing address

5385 NE 2ND AVE
MIAMI FL
33137-2707
US

V. Phone/Fax

Practice location:
  • Phone: 305-756-9977
  • Fax: 305-756-5757
Mailing address:
  • Phone: 305-756-9977
  • Fax: 305-756-5757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BLAIR N RETCHIN
Title or Position: PRESIDENT
Credential:
Phone: 305-756-9977