MEDICARE: TARIQ KUTOB 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	207Q00000X	Family Medicine Physician	4301060391	MI
2	207R00000X	Internal Medicine Physician	ME156735	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	:	1497844120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARIQ KUTOB MD

Provider Business Mailing Address
First Line	:	7800 66TH ST N STE 101
Second Line	:
City	:	PINELLAS PARK
State	:	FL
Zip	:	33781-2101
Country	:	US
Telephone Number	:	727-546-5702
Fax Number	:	727-546-5700

Provider Business Practice Location Address
First Line	:	7800 66TH ST N STE 101
Second Line	:
City	:	PINELLAS PARK
State	:	FL
Zip	:	33781-2101
Country	:	US
Telephone Number	:	727-546-5702
Fax Number	:	727-546-5700

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	05/07/2025

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Directions to “ TARIQ KUTOB MD” Practice Location

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