MEDICARE: TAHA MED PLLC

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	ME96911	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	:	1871978973
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAHA MED PLLC

Provider Business Mailing Address
First Line	:	4112 ISLAND LAKES DR
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33881-5605
Country	:	US
Telephone Number	:	863-594-8354
Fax Number	:

Provider Business Practice Location Address
First Line	:	4112 ISLAND LAKES DR
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33881-5605
Country	:	US
Telephone Number	:	863-594-8354
Fax Number	:	407-386-7878

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TAHA DIAS
Credential	:	M.D.
Telephone Number	:	863-594-8354

Provider Enumeration Date	:	07/30/2015
Last Update Date	:	01/27/2020

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