Healthcare Provider Details

I. General information

NPI: 1710418165
Provider Name (Legal Business Name): JONATHON TSAI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 VAN DYKE RD STE 200
LUTZ FL
33558-8005
US

IV. Provider business mailing address

4211 VAN DYKE RD STE 200
LUTZ FL
33558-8005
US

V. Phone/Fax

Practice location:
  • Phone: 813-264-6490
  • Fax:
Mailing address:
  • Phone: 813-264-6490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME155479
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: