Provider Demographics
NPI:1801813829
Name:AGZEW, YESHITILA (MD)
Entity Type:Individual
Prefix:
First Name:YESHITILA
Middle Name:
Last Name:AGZEW
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 1:19947 TAMIAMI AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3366
Mailing Address - Country:US
Mailing Address - Phone:813-716-6959
Mailing Address - Fax:813-929-7708
Practice Address - Street 1:19947 TAMIAMI AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647
Practice Address - Country:US
Practice Address - Phone:813-716-6959
Practice Address - Fax:813-929-7708
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0082835207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE75072Medicare UPIN