Provider Demographics
NPI:1629030127
Name:TAMBOLI, HOSHEDAR PHEROZE (MD)
Entity Type:Individual
Prefix:
First Name:HOSHEDAR
Middle Name:PHEROZE
Last Name:TAMBOLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:813-755-3500
Practice Address - Fax:813-755-3300
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0060434207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373330100Medicaid
FL17858ZMedicare ID - Type Unspecified
FL373330100Medicaid