MEDICARE: DR. MARIO ENRIQUE TANO 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	2080P0206X	Pediatric Gastroenterology Physician	ME58352	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	:	1174510341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIO ENRIQUE TANO MD

Provider Business Mailing Address
First Line	:	5955 PONCE DE LEON BLVD.
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33146
Country	:	US
Telephone Number	:	305-661-1515
Fax Number	:	305-662-3723

Provider Business Practice Location Address
First Line	:	3800 JOHNSON ST STE J
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6030
Country	:	US
Telephone Number	:	954-967-9400
Fax Number	:	954-967-9551

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

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	02/08/2022

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