MEDICARE: TANWEER MEMON MD PA

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	207R00000X	Internal Medicine Physician	ME0074367	FL

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	42648	OTHER	FL	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841216421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TANWEER MEMON MD PA

Provider Business Mailing Address
First Line	:	2852 TAMIAMI TRL STE 5
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-5100
Country	:	US
Telephone Number	:	941-625-9494
Fax Number	:	941-743-8562

Provider Business Practice Location Address
First Line	:	2852 TAMIAMI TRL STE 5
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-5100
Country	:	US
Telephone Number	:	941-625-9494
Fax Number	:	941-743-8562

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. TANWEER MEMON
Credential	:	M.D., P.A.
Telephone Number	:	941-625-9494

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	12/17/2025

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