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NPI Code Detail

MEDICARE: PINNACLE HEALTH GROUP P.A.

MEDICARE: PINNACLE HEALTH GROUP P.A.
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
1207R00000XInternal Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1ME71925OTHERFLMED LICENSE

General Provider Information

NPI Number : 1720738669
Entity Type Code : Organization
Provider Name (Legal Business Name) : PINNACLE HEALTH GROUP P.A.
Provider Business Mailing Address
First Line : PO BOX 18344
Second Line :
City : TAMPA
State : FL
Zip : 33679-8344
Country : US
Telephone Number : 813-874-5500
Fax Number : 813-874-5505
Provider Business Practice Location Address
First Line : 2590 HEALING WAY STE 110
Second Line :
City : WESLEY CHAPEL
State : FL
Zip : 33543-5496
Country : US
Telephone Number : 813-874-5500
Fax Number : 813-874-5505
Authorized Official
Title or Position : PRESIDENT/MEDICAL DIRECTOR
Name : SAM DIASTI
Credential : MD
Telephone Number : 813-874-5500
Provider Enumeration Date : 03/24/2022
Last Update Date : 03/31/2022

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