Provider Demographics
NPI:1417962267
Name:SAK, TEW AMPOL (MD)
Entity Type:Individual
Prefix:DR
First Name:TEW
Middle Name:AMPOL
Last Name:SAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6719 GALL BLVD
Mailing Address - Street 2:STE 107
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-2571
Mailing Address - Country:US
Mailing Address - Phone:813-782-4113
Mailing Address - Fax:813-788-2460
Practice Address - Street 1:6719 GALL BLVD
Practice Address - Street 2:STE 107
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-2571
Practice Address - Country:US
Practice Address - Phone:813-782-4113
Practice Address - Fax:813-788-2460
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME43869207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068995500Medicaid
D56015Medicare UPIN
FL068995500Medicaid