Provider Demographics
NPI:1083878656
Name:TAEB, PARISIMA (MD)
Entity Type:Individual
Prefix:
First Name:PARISIMA
Middle Name:
Last Name:TAEB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5410 MARYLAND WAY STE 300
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5339
Mailing Address - Country:US
Mailing Address - Phone:615-371-5744
Mailing Address - Fax:888-241-1404
Practice Address - Street 1:2776 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-5864
Practice Address - Country:US
Practice Address - Phone:239-343-2837
Practice Address - Fax:239-343-3164
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01066717A208M00000X
PAMT189463207R00000X
FLME106617208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000640373OtherANTHEM PROVIDER NUMBER
IN200974170Medicaid
IN000000640373OtherANTHEM PROVIDER NUMBER
IN200974170Medicaid
INP00782513Medicare PIN