MEDICARE: INTERNAL MEDICINE ASSOCIATES OF NORTH TAMPA PA

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	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	068100	OTHER		AETNA
2	45144	OTHER		BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1497717623
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERNAL MEDICINE ASSOCIATES OF NORTH TAMPA PA

Provider Business Mailing Address
First Line	:	3661 MADACA LN
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-2048
Country	:	US
Telephone Number	:	813-968-7830
Fax Number	:	813-265-9697

Provider Business Practice Location Address
First Line	:	3661 MADACA LN
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-2048
Country	:	US
Telephone Number	:	813-968-7830
Fax Number	:	813-265-9697

Authorized Official
Title or Position	:	OWNER
Name	:	BRUCE A KAHAN
Credential	:	M.D.
Telephone Number	:	813-968-7830

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	09/22/2009

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