Healthcare Provider Details

I. General information

NPI: 1902364599
Provider Name (Legal Business Name): MARTEKEI PLANGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2019
Last Update Date: 03/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1418 E BUSCH BLVD STE 104
TAMPA FL
33612-8692
US

IV. Provider business mailing address

5474 WILLIAMS RD STE 2B
TAMPA FL
33610-9167
US

V. Phone/Fax

Practice location:
  • Phone: 813-278-9308
  • Fax: 813-433-5112
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: