MEDICARE: DR. TONANTZIN MATHEUS 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	207RG0100X	Gastroenterology Physician	ME100744	FL

General Provider Information

NPI Number	:	1629245683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TONANTZIN MATHEUS MD

Provider Business Mailing Address
First Line	:	6600 UNIVERSITY PKWY STE 301
Second Line	:
City	:	LAKEWOOD RANCH
State	:	FL
Zip	:	34240-9048
Country	:	US
Telephone Number	:	941-361-1100
Fax Number	:	941-361-1103

Provider Business Practice Location Address
First Line	:	6600 UNIVERSITY PKWY STE 301
Second Line	:
City	:	LAKEWOOD RANCH
State	:	FL
Zip	:	34240-9048
Country	:	US
Telephone Number	:	941-361-1100
Fax Number	:	941-361-1103

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

Provider Enumeration Date	:	05/09/2008
Last Update Date	:	05/08/2024

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