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NPI Code Detail

MEDICARE: DR. MICHAEL TAVDY M.D.

MEDICARE: DR. MICHAEL TAVDY 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
1207R00000XInternal Medicine Physician221582NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1720016793
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL TAVDY M.D.
Provider Business Mailing Address
First Line : 6636 YELLOWSTONE BLVD APT 8H
Second Line :
City : FOREST HILLS
State : NY
Zip : 11375-2552
Country : US
Telephone Number : 718-997-1722
Fax Number : 718-333-1023
Provider Business Practice Location Address
First Line : 2705 MERMAID AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11224-2005
Country : US
Telephone Number : 718-265-2222
Fax Number : 718-333-1023
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2006
Last Update Date : 07/08/2007

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