MEDICARE: MEDICAL PLAZA MANAGEMENT, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician
2	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1083995336
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL PLAZA MANAGEMENT, INC.

Provider Business Mailing Address
First Line	:	5385 NE 2ND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33137-2707
Country	:	US
Telephone Number	:	305-756-9977
Fax Number	:	305-756-5757

Provider Business Practice Location Address
First Line	:	5385 NE 2ND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33137-2707
Country	:	US
Telephone Number	:	305-756-9977
Fax Number	:	305-756-5757

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BLAIR N RETCHIN
Credential	:
Telephone Number	:	305-756-9977

Provider Enumeration Date	:	08/31/2011
Last Update Date	:	08/31/2011

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