MEDICARE: PINNACLE HEALTH GROUP PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME71925	FL

General Provider Information

NPI Number	:	1023004231
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINNACLE HEALTH GROUP PA

Provider Business Mailing Address
First Line	:	PO BOX 18344
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33679-8344
Country	:	US
Telephone Number	:	813-874-5500
Fax Number	:	813-874-5505

Provider Business Practice Location Address
First Line	:	2605 W SWANN AVE
Second Line	:	STE 100
City	:	TAMPA
State	:	FL
Zip	:	33609-4039
Country	:	US
Telephone Number	:	813-874-5500
Fax Number	:	813-874-5505

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SAM DIASTI
Credential	:	MD
Telephone Number	:	813-874-5500

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	03/31/2022

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