Healthcare Provider Details

I. General information

NPI: 1225639412
Provider Name (Legal Business Name): PLESSEN MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2020
Last Update Date: 02/16/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SUNNY ISLES SHOPPING CENTER SPACE #1, 2, AND 3A
CHRISTIANSTED VI
00820
US

IV. Provider business mailing address

3004 ORANGE GROVE
CHRISTIANSTED VI
00820
US

V. Phone/Fax

Practice location:
  • Phone: 340-715-7720
  • Fax:
Mailing address:
  • Phone: 340-201-3157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAN TAWAKOL
Title or Position: CEO
Credential:
Phone: 602-885-3917