Healthcare Provider Details

I. General information

NPI: 1164943163
Provider Name (Legal Business Name): ANUM TANVIR DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2017
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2441 SURFSIDE BLVD
CAPE CORAL FL
33914-3861
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-541-7500
  • Fax: 239-541-7501
Mailing address:
  • Phone: 239-541-7500
  • Fax: 239-541-7501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A16807
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS20775
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: