Healthcare Provider Details

I. General information

NPI: 1104155977
Provider Name (Legal Business Name): NOEL S TENENBAUM MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2009
Last Update Date: 12/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 ALT 19
PALM HARBOR FL
34683-5338
US

IV. Provider business mailing address

220 ALT 19
PALM HARBOR FL
34683-5338
US

V. Phone/Fax

Practice location:
  • Phone: 727-786-6921
  • Fax:
Mailing address:
  • Phone: 727-786-6921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME64981
License Number StateFL

VIII. Authorized Official

Name: NOEL S TENENBAUM
Title or Position: OWNER
Credential:
Phone: 727-786-6921