MEDICARE: DR. TEW AMPOL SAK MD

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	207Y00000X	Otolaryngology Physician	ME43869	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

General Provider Information

NPI Number	:	1417962267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TEW AMPOL SAK MD

Provider Business Mailing Address
First Line	:	6719 GALL BLVD
Second Line	:	STE 107
City	:	ZEPHYRHILLS
State	:	FL
Zip	:	33542-2571
Country	:	US
Telephone Number	:	813-782-4113
Fax Number	:	813-788-2460

Provider Business Practice Location Address
First Line	:	6719 GALL BLVD
Second Line	:	STE 107
City	:	ZEPHYRHILLS
State	:	FL
Zip	:	33542-2571
Country	:	US
Telephone Number	:	813-782-4113
Fax Number	:	813-788-2460

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

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	01/20/2009

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