MEDICARE: DR. AMANOLLAH -- TABESH 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	207Y00000X	Otolaryngology Physician	ME41543	FL

General Provider Information

NPI Number	:	1821049826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMANOLLAH -- TABESH M.D.

Provider Business Mailing Address
First Line	:	10131 WHITE TROUT LN
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-4309
Country	:	US
Telephone Number	:	813-935-9509
Fax Number	:

Provider Business Practice Location Address
First Line	:	7001 N DALE MABRY HWY
Second Line	:	SUITE # 3
City	:	TAMPA
State	:	FL
Zip	:	33614-3910
Country	:	US
Telephone Number	:	813-932-0804
Fax Number	:	813-932-8163

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

Provider Enumeration Date	:	05/14/2006
Last Update Date	:	07/08/2007

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