MEDICARE: DR. ISLAM TAFISH 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	2084N0400X	Neurology Physician	036156075	IL
2	2084N0400X	Neurology Physician	ME124378	FL
3	2084N0400X	Neurology Physician	38362	IA
4	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	036156075	IL

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	:	1629175526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ISLAM TAFISH M.D.

Provider Business Mailing Address
First Line	:	1665 KINGSLEY AVE
Second Line	:	SUITE 107
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-4490
Country	:	US
Telephone Number	:	904-272-9981
Fax Number	:	904-272-9982

Provider Business Practice Location Address
First Line	:	1665 KINGSLEY AVE
Second Line	:	SUITE 107
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-4490
Country	:	US
Telephone Number	:	904-272-9981
Fax Number	:	904-272-9982

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	05/06/2026

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Directions to “ DR. ISLAM TAFISH M.D.” Practice Location

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