Provider Demographics
NPI:1235370735
Name:IMAD E TARABISHY MD PA
Entity Type:Organization
Organization Name:IMAD E TARABISHY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IMAD
Authorized Official - Middle Name:E
Authorized Official - Last Name:TARABISHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-596-8558
Mailing Address - Street 1:11339 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-5404
Mailing Address - Country:US
Mailing Address - Phone:352-596-8558
Mailing Address - Fax:352-596-3494
Practice Address - Street 1:11339 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5404
Practice Address - Country:US
Practice Address - Phone:352-596-8558
Practice Address - Fax:352-596-3494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-12
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0044203207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0978050001Medicare NSC
FL26063Medicare PIN