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NPI Code Detail

MEDICARE: TAMARA THRELKELD PISTORIA DO

MEDICARE: TAMARA THRELKELD PISTORIA DO
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
1208000000XPediatrics PhysicianOS0008614FL

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 : 1932107158
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAMARA THRELKELD PISTORIA DO
Provider Business Mailing Address
First Line : PO BOX 95004
Second Line :
City : LAKELAND
State : FL
Zip : 33804-5004
Country : US
Telephone Number : 863-680-7000
Fax Number : 863-680-7420
Provider Business Practice Location Address
First Line : 1033 N PARKWAY FRONTAGE RD
Second Line :
City : LAKELAND
State : FL
Zip : 33803-0401
Country : US
Telephone Number : 863-647-8011
Fax Number : 863-647-8029
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2005
Last Update Date : 06/26/2012

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Directions to “ TAMARA THRELKELD PISTORIA DO” Practice Location

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