MEDICARE: DR. TANWEER A MEMON M.D.

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	ME0074367	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	5236702	OTHER	FL	AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	42648	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1053304774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TANWEER A MEMON M.D.

Provider Business Mailing Address
First Line	:	2852 TAMIAMI TRL STE 5
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-5100
Country	:	US
Telephone Number	:	941-625-9494
Fax Number	:	941-743-8562

Provider Business Practice Location Address
First Line	:	2852 TAMIAMI TRL STE 5
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-5100
Country	:	US
Telephone Number	:	941-625-9494
Fax Number	:	941-743-8562

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2005
Last Update Date	:	12/17/2025

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