Provider Demographics
NPI:1053304774
Name:MEMON, TANWEER A (MD)
Entity Type:Individual
Prefix:DR
First Name:TANWEER
Middle Name:A
Last Name:MEMON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2091 TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-2112
Mailing Address - Country:US
Mailing Address - Phone:941-625-9494
Mailing Address - Fax:941-743-8562
Practice Address - Street 1:2091 TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-2112
Practice Address - Country:US
Practice Address - Phone:941-625-9494
Practice Address - Fax:941-743-8562
Is Sole Proprietor?:No
Enumeration Date:2005-08-28
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0074367207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5236702OtherAETNA
FL258993100Medicaid
FL42648OtherBCBS
FL42648OtherBCBS
FL110156579Medicare PIN
FL258993100Medicaid