1558445023 NPI number — DR. JONATHAN MICHAEL TUMAN DDS

Table of content: DR. JONATHAN MICHAEL TUMAN DDS (NPI 1558445023)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558445023 NPI number — DR. JONATHAN MICHAEL TUMAN DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TUMAN
Provider First Name:
JONATHAN
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558445023
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1111 KANE CONCOURSE
Provider Second Line Business Mailing Address:
#515
Provider Business Mailing Address City Name:
BAY HARBOR ISLANDS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33154-2029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-865-7166
Provider Business Mailing Address Fax Number:
305-861-7870

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1111 KANE CONCOURSE
Provider Second Line Business Practice Location Address:
#515
Provider Business Practice Location Address City Name:
BAY HARBOR ISLANDS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33154-2029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-865-7166
Provider Business Practice Location Address Fax Number:
305-861-7870
Provider Enumeration Date:
10/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DN12806 , 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)

  • Identifier: 004233200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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