MEDICARE: DR. MYRON TANENBAUM 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	207W00000X	Ophthalmology Physician	0041105	FL
2	207WX0200X	Ophthalmic Plastic and Reconstructive Surgery Physician	41105	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225091473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MYRON TANENBAUM M.D.

Provider Business Mailing Address
First Line	:	7765 SW 87TH AVE
Second Line	:	SUITE 210
City	:	MIAMI
State	:	FL
Zip	:	33173-2596
Country	:	US
Telephone Number	:	305-273-5353
Fax Number	:	305-273-0496

Provider Business Practice Location Address
First Line	:	7765 SW 87TH AVE
Second Line	:	SUITE 210
City	:	MIAMI
State	:	FL
Zip	:	33173-2596
Country	:	US
Telephone Number	:	305-273-5353
Fax Number	:	305-273-0496

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

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	05/02/2016

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