MEDICARE: DR. GAMAL M WAZNI 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	4301082006	MI

General Provider Information

NPI Number	:	1730243874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GAMAL M WAZNI MD

Provider Business Mailing Address
First Line	:	3810 NORTHDALE BLVD STE 150
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-1871
Country	:	US
Telephone Number	:	813-961-1331
Fax Number	:	888-850-8316

Provider Business Practice Location Address
First Line	:	3810 NORTHDALE BLVD STE 150
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-1871
Country	:	US
Telephone Number	:	813-961-1331
Fax Number	:	888-850-8316

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

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	04/15/2020

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