MEDICARE: DR. WAGDY TADROS M.D.

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	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	ME65248	FL
2	207R00000X	Internal Medicine Physician	ME65248	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	:	1114952413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WAGDY TADROS M.D.

Provider Business Mailing Address
First Line	:	4469 N STATE ROAD 7
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33319-5876
Country	:	US
Telephone Number	:	954-486-1966
Fax Number	:	954-486-9115

Provider Business Practice Location Address
First Line	:	4469 N STATE ROAD 7
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33319-5876
Country	:	US
Telephone Number	:	954-486-1966
Fax Number	:	954-486-9115

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	10/15/2019

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