1912366428 NPI number — THYROID ENDOCRINOLOGY AND DIABETES SPECIALISTS OF TAMPA LLC

Table of content: (NPI 1912366428)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912366428 NPI number — THYROID ENDOCRINOLOGY AND DIABETES SPECIALISTS OF TAMPA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THYROID ENDOCRINOLOGY AND DIABETES SPECIALISTS OF TAMPA LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
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Provider Other Middle Name:
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NPI Number Information

NPI Number:
1912366428
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4030 HENDERSON BLVD STE 701
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33629-4940
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-474-3636
Provider Business Mailing Address Fax Number:
813-862-2536

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2204 ASHLEY OAKS CIR
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
WESLEY CHAPEL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33544-6426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-474-3636
Provider Business Practice Location Address Fax Number:
813-862-2536
Provider Enumeration Date:
02/12/2016

Additional Information

Authorized Official

Authorized Official Last Name:
QURESHI
Authorized Official First Name:
AMBREEN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
813-474-3636

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X , with the licence number:  ME115520 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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