Provider Demographics
NPI:1437147097
Name:TANIS, ARNOLD L (MD)
Entity Type:Individual
Prefix:
First Name:ARNOLD
Middle Name:L
Last Name:TANIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4620 N STATE ROAD 7
Mailing Address - Street 2:STE 316
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33319-5884
Mailing Address - Country:US
Mailing Address - Phone:954-967-6400
Mailing Address - Fax:954-967-6410
Practice Address - Street 1:4500 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3516
Practice Address - Country:US
Practice Address - Phone:954-966-8000
Practice Address - Fax:954-966-6614
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-07
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
FLME6703208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
D51499Medicare UPIN