Provider Demographics
NPI:1225091473
Name:TANENBAUM, MYRON (MD)
Entity Type:Individual
Prefix:DR
First Name:MYRON
Middle Name:
Last Name:TANENBAUM
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 1:7765 SW 87TH AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-2596
Mailing Address - Country:US
Mailing Address - Phone:305-273-5353
Mailing Address - Fax:305-273-0496
Practice Address - Street 1:7765 SW 87TH AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-2596
Practice Address - Country:US
Practice Address - Phone:305-273-5353
Practice Address - Fax:305-273-0496
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0041105207W00000X
FL41105207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0489972-00Medicaid
FL34064Medicare ID - Type Unspecified
FL0489972-00Medicaid