Provider Demographics
NPI:1528129988
Name:MACEK, TOM (MD)
Entity type:Individual
Prefix:
First Name:TOM
Middle Name:
Last Name:MACEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15275 COLLIER BLVD # 201291
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-6750
Mailing Address - Country:US
Mailing Address - Phone:236-690-7791
Mailing Address - Fax:239-692-8347
Practice Address - Street 1:1164 E OAKLAND PARK BLVD STE 201
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-2709
Practice Address - Country:US
Practice Address - Phone:954-678-1074
Practice Address - Fax:954-628-3351
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98363208VP0014X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AD899ZMedicare PIN
FLAD899XMedicare PIN