Healthcare Provider Details

I. General information

NPI: 1518580307
Provider Name (Legal Business Name): HEART VASCULAR AND VEIN OF TAMPA BAY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2020
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 W LUMSDEN RD
BRANDON FL
33511-5911
US

IV. Provider business mailing address

PO BOX 1910
BRANDON FL
33509-1910
US

V. Phone/Fax

Practice location:
  • Phone: 813-755-4500
  • Fax: 813-755-3300
Mailing address:
  • Phone: 813-755-3500
  • Fax: 813-755-3300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. HOSHEDAR TAMBOLI
Title or Position: PRESIDENT
Credential: MD
Phone: 813-755-3500