MEDICARE: DR. TARUN TEWATIA 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	208M00000X	Hospitalist Physician	ME94994	FL
2	207R00000X	Internal Medicine Physician	ME94994	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	NC895	OTHER	FL	FL HF MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	37007	OTHER	FL	BLUE SHIELD OF FL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285679209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TARUN TEWATIA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 361095
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32936-1095
Country	:	US
Telephone Number	:	321-253-2900
Fax Number	:	321-435-0100

Provider Business Practice Location Address
First Line	:	2200 W EAU GALLIE BLVD STE 200
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32935-3166
Country	:	US
Telephone Number	:	321-253-2900
Fax Number	:	321-435-0100

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

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	12/22/2020

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Directions to “ DR. TARUN TEWATIA M.D.” Practice Location

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