Healthcare Provider Details

I. General information

NPI: 1114117587
Provider Name (Legal Business Name): RADEMAKER PLASTIC SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 11/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11932 SHELDON ROAD
TAMPA FL
33626-3643
US

IV. Provider business mailing address

11932 SHELDON ROAD
TAMPA FL
33626-3643
US

V. Phone/Fax

Practice location:
  • Phone: 813-884-0160
  • Fax: 813-885-9383
Mailing address:
  • Phone: 813-884-0160
  • Fax: 813-885-9383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: BART RADEMAKER
Title or Position: OWNER
Credential: M.D.
Phone: 813-884-0160