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NPI Code Detail

MEDICARE: IMAD FOUAD TABRY M.D.

MEDICARE: IMAD FOUAD TABRY 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
1208G00000XThoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianME36437FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1790784049
Entity Type Code : Individual
Provider Name (Legal Business Name) : IMAD FOUAD TABRY M.D.
Provider Business Mailing Address
First Line : 4725 N FEDERAL HWY
Second Line :
City : FT LAUDERDALE
State : FL
Zip : 33308-4603
Country : US
Telephone Number : 954-267-6770
Fax Number : 954-267-6769
Provider Business Practice Location Address
First Line : 4725 N FEDERAL HWY
Second Line :
City : FT LAUDERDALE
State : FL
Zip : 33308-4603
Country : US
Telephone Number : 954-267-6770
Fax Number : 954-267-6769
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2005
Last Update Date : 06/15/2012

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