Provider Demographics
NPI:1497717623
Name:INTERNAL MEDICINE ASSOCIATES OF NORTH TAMPA PA
Entity Type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES OF NORTH TAMPA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-968-7830
Mailing Address - Street 1:3661 MADACA LN
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2048
Mailing Address - Country:US
Mailing Address - Phone:813-968-7830
Mailing Address - Fax:813-265-9697
Practice Address - Street 1:3661 MADACA LN
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2048
Practice Address - Country:US
Practice Address - Phone:813-968-7830
Practice Address - Fax:813-265-9697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
068100OtherAETNA
45144OtherBLUE CROSS BLUE SHIELD
45144OtherBLUE CROSS BLUE SHIELD