Healthcare Provider Details

I. General information

NPI: 1982935425
Provider Name (Legal Business Name): RICHARD E TANNENBAUM MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2010
Last Update Date: 01/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 SW 92ND ST SUITE 208
MIAMI FL
33156-7390
US

IV. Provider business mailing address

8500 SW 92ND ST SUITE 208
MIAMI FL
33156-7390
US

V. Phone/Fax

Practice location:
  • Phone: 305-271-9811
  • Fax: 305-271-9821
Mailing address:
  • Phone: 305-271-9811
  • Fax: 305-271-9821

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: RICHARD E TANNENBAUM
Title or Position: PRESIDENT
Credential: MD
Phone: 305-271-9811