Organization
MEDPLAN CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MANUEL IGLESIAS (CEO)
(786) 641-5348
Entity
Organization
Contact information
Practice address
900 W 49TH ST STE 308, HIALEAH, FL 33012-3435
(305) 801-6952
Mailing address
8750 NW 36TH STREET, SUITE 300, DORAL, FL 33178
(786) 641-5348
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
O18781000
—
FL
Enumeration date
02/03/2014
Last updated
06/12/2017
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