MEDICARE: DR. MARWAN RIAD TABBARA 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	2086S0129X	Vascular Surgery Physician	ME-0045701	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	:	1396734869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARWAN RIAD TABBARA M.D.

Provider Business Mailing Address
First Line	:	20101 NE 25TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33180-1822
Country	:	US
Telephone Number	:	305-931-6052
Fax Number	:

Provider Business Practice Location Address
First Line	:	2951 NW 49TH AVE
Second Line	:	SUITE 204, CENTRAL BLDG
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33313-1600
Country	:	US
Telephone Number	:	954-486-5311
Fax Number	:

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

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	07/08/2007

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