Healthcare Provider Details

I. General information

NPI: 1699785295
Provider Name (Legal Business Name): MICHAEL D. THARP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 KYLE WOOD LN
BRANDON FL
33511-4850
US

IV. Provider business mailing address

4919 MEMORIAL HWY STE 150
TAMPA FL
33634-7516
US

V. Phone/Fax

Practice location:
  • Phone: 813-948-7550
  • Fax: 813-948-7566
Mailing address:
  • Phone: 813-333-1512
  • Fax: 813-333-1561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME133157
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: