MEDICARE: DR. ISSAM I ALBANNA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	ME0061731	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023007135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ISSAM I ALBANNA MD

Provider Business Mailing Address
First Line	:	3288 COVE BEND DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33613-2752
Country	:	US
Telephone Number	:	813-979-4435
Fax Number	:	813-979-4026

Provider Business Practice Location Address
First Line	:	3288 COVE BEND DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33613-2752
Country	:	US
Telephone Number	:	813-979-4435
Fax Number	:	813-979-4026

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	11/03/2011

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Directions to “ DR. ISSAM I ALBANNA MD” Practice Location

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