MEDICARE: NAZANIN ROBOUBI DPM

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	213E00000X	Podiatrist	PO3060	FL

General Provider Information

NPI Number	:	1801888706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAZANIN ROBOUBI DPM

Provider Business Mailing Address
First Line	:	36181 E LAKE RD
Second Line	:	SUITE 55
City	:	PALM HARBOR
State	:	FL
Zip	:	34685-3142
Country	:	US
Telephone Number	:	727-631-1592
Fax Number	:	727-787-8170

Provider Business Practice Location Address
First Line	:	1840 MEASE DR
Second Line	:	SUITE 315
City	:	SAFETY HARBOR
State	:	FL
Zip	:	34695-6602
Country	:	US
Telephone Number	:	727-631-1592
Fax Number	:	727-631-1592

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

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	10/02/2012

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