PSYCHIATRIC PROFESSIONAL SERVICES PA
Psychiatric at Park Ave, Winter Park, FL

License number
Florida ME0050631
Category
Psychiatric
Type
Psychiatry
Owner
Name: JOHN LOUIS BLANKEMEIER MD
Title: OWNER
Phone: (407) 629-6440
Address
Address
2180 N Park Ave SUITE 320, Winter Park, FL 32789
National Provider ID: 1518020775
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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PSYCHIATRIC PROFESSIONAL SERVICES, PA

2180 N Park Ave SUITE 320, Winter Park, FL 32789

Registration:
Mar 15, 1994
State ID:
P94000021001
Business type:
Florida Profit Corporation
Vice Presidents:
John L Blankemeier (President, Treasurer, Secretary), 2180 N Park Ave SUITE #320, Winter Park, FL 32789 (Physical),Susanne F Blankemeier (Vice President), 2180 N Park Ave SUITE #320, Winter Park, FL 32789 (Physical)
Agent:
John Blankemeier,2180 N Park Ave SUITE 320, Winter Park, FL 32789 (Physical)
EIN:
59-3232349

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