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General NPI Number Information
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NPI Number | 1114117587
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Entity Type | Organization
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Legal Business Name | RADEMAKER PLASTIC SURGERY LLC
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Dates
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Enumeration Date | 07/31/2007
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Last Update Date | 11/02/2010
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Provider Practice Location Address
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Address Line | 11932 SHELDON ROAD
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City | TAMPA
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State | FL
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Zip | 33626-3643
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Country | US
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Telephone | 813-884-0160
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Fax | 813-885-9383
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Provider Business Mailing Address
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Address Line | 11932 SHELDON ROAD
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City | TAMPA
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State | FL
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Zip | 33626-3643
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Country | US
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Telephone | 813-884-0160
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Fax | 813-885-9383
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Authorized Official
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Title or Position | OWNER
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Name | BART RADEMAKER
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Credential | M.D.
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Telephone | 813-884-0160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number |
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License Number State |
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