Healthcare Provider Details

I. General information

NPI: 1194895243
Provider Name (Legal Business Name): TANVEER P MIR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 10/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N ORANGE AVE SUITE 235
ORLANDO FL
32804-4603
US

IV. Provider business mailing address

2501 N ORANGE AVE SUITE 235
ORLANDO FL
32804-4603
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-2906
  • Fax: 407-303-7126
Mailing address:
  • Phone: 407-303-2906
  • Fax: 407-303-7126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberME 125740
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberME 125740
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number179063
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number179063
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: