Organization
MED PLAN CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MANUEL IGLEASIAS (CEO)
(786) 641-5348
Entity
Organization
Contact information
Practice address
9959 PINES BLVD, PEMBROKE PINES, FL 33024-6177
(954) 433-2524
Mailing address
3155 NW 77TH AVE, MIAMI, FL 33122-1205
(305) 790-8129
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
O18781000
—
FL
Enumeration date
04/20/2016
Last updated
06/12/2017
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