MEDICARE: AMANOLLAH TABESH 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	261Q00000X	Clinic/Center	ME41543	FL
2	207Y00000X	Otolaryngology Physician	ME41543	FL

General Provider Information

NPI Number	:	1861428062
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMANOLLAH TABESH MD PA

Provider Business Mailing 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

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	:	DIRECTOR
Name	:	AMANOLLAH TABESH
Credential	:	MD
Telephone Number	:	813-932-0804

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	02/28/2008

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