Provider Demographics
NPI:1790844066
Name:TENENBAUM, NOEL (MD)
Entity Type:Individual
Prefix:
First Name:NOEL
Middle Name:
Last Name:TENENBAUM
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 1:220 ALT 19
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-5338
Mailing Address - Country:US
Mailing Address - Phone:727-786-6921
Mailing Address - Fax:727-781-2265
Practice Address - Street 1:220 ALT 19
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-5338
Practice Address - Country:US
Practice Address - Phone:727-786-6921
Practice Address - Fax:727-781-2265
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64981208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF31969Medicare UPIN
FL23958Medicare ID - Type Unspecified