Healthcare Provider Details

I. General information

NPI: 1134304983
Provider Name (Legal Business Name): CRAIG PETER TANIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2007
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 HARRISON ST STE 404
HOLLYWOOD FL
33020-7829
US

IV. Provider business mailing address

1930 HARRISON ST STE 404
HOLLYWOOD FL
33020-7829
US

V. Phone/Fax

Practice location:
  • Phone: 786-780-1188
  • Fax:
Mailing address:
  • Phone: 410-404-3408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME118755
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: