Provider Demographics
NPI:1417958497
Name:TAUNK, VIJAY (MD)
Entity Type:Individual
Prefix:DR
First Name:VIJAY
Middle Name:
Last Name:TAUNK
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 1:2595 TAMPA RD
Mailing Address - Street 2:SUITE K
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3152
Mailing Address - Country:US
Mailing Address - Phone:727-789-6551
Mailing Address - Fax:727-789-4759
Practice Address - Street 1:2595 TAMPA RD
Practice Address - Street 2:SUITE K
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3152
Practice Address - Country:US
Practice Address - Phone:727-789-6551
Practice Address - Fax:727-789-4759
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64536207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373199500Medicaid
FL70103Medicare UPIN
FL23400AMedicare ID - Type Unspecified