Provider Demographics
NPI:1518580307
Name:HEART VASCULAR AND VEIN OF TAMPA BAY LLC
Entity Type:Organization
Organization Name:HEART VASCULAR AND VEIN OF TAMPA BAY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOSHEDAR
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMBOLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-755-3500
Mailing Address - Street 1:PO BOX 1910
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33509-1910
Mailing Address - Country:US
Mailing Address - Phone:813-755-3500
Mailing Address - Fax:813-755-3300
Practice Address - Street 1:621 W LUMSDEN RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5911
Practice Address - Country:US
Practice Address - Phone:813-755-4500
Practice Address - Fax:813-755-3300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-27
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373330100Medicaid