Healthcare Provider Details

I. General information

NPI: 1023007135
Provider Name (Legal Business Name): ISSAM I ALBANNA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3288 COVE BEND DR
TAMPA FL
33613-2752
US

IV. Provider business mailing address

3288 COVE BEND DR
TAMPA FL
33613-2752
US

V. Phone/Fax

Practice location:
  • Phone: 813-979-4435
  • Fax: 813-979-4026
Mailing address:
  • Phone: 813-979-4435
  • Fax: 813-979-4026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0061731
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: