Provider Demographics
NPI:1588816516
Name:TEW A SAK MD PA
Entity Type:Organization
Organization Name:TEW A SAK MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TEW
Authorized Official - Middle Name:A
Authorized Official - Last Name:SAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-782-4113
Mailing Address - Street 1:6719 GALL BLVD
Mailing Address - Street 2:STE 107 TEW A SAK MD
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-2568
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 TEW A SAK MD
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-2568
Practice Address - Country:US
Practice Address - Phone:813-782-4113
Practice Address - Fax:813-788-2460
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEW A SAK MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-22
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43869207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068995500Medicaid
FL068995500Medicaid