Healthcare Provider Details

I. General information

NPI: 1609862515
Provider Name (Legal Business Name): DR. JEREMY TABAK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 SW 92ND ST STE 204B
MIAMI FL
33156-7377
US

IV. Provider business mailing address

8600 SW 92ND ST SUITE 204A
MIAMI FL
33156-7397
US

V. Phone/Fax

Practice location:
  • Phone: 305-661-9404
  • Fax: 305-661-1510
Mailing address:
  • Phone: 305-436-9933
  • Fax: 305-436-9944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME37905
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberME37905
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME37905
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: