Provider Demographics
NPI:1790305340
Name:CORAL SPRINGS PULMONARY MEDICINE, P.A.
Entity Type:Organization
Organization Name:CORAL SPRINGS PULMONARY MEDICINE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BASHEER
Authorized Official - Middle Name:
Authorized Official - Last Name:TASHTOUSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-309-8591
Mailing Address - Street 1:2507 PROVENCE CIR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33327-1302
Mailing Address - Country:US
Mailing Address - Phone:404-309-8591
Mailing Address - Fax:
Practice Address - Street 1:10752 HAWKS VISTA ST
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-8212
Practice Address - Country:US
Practice Address - Phone:404-309-8591
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-23
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty