Healthcare Provider Details

I. General information

NPI: 1952316689
Provider Name (Legal Business Name): TAHSEEN IZHAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 07/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 NE 19TH DRIVE
OKEECHOBEE FL
34972-1918
US

IV. Provider business mailing address

2055 S US HIGHWAY 1
VERO BEACH FL
32962-7206
US

V. Phone/Fax

Practice location:
  • Phone: 863-357-9677
  • Fax: 863-763-4509
Mailing address:
  • Phone: 772-794-0030
  • Fax: 772-794-0379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME82236
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: