Provider Demographics
NPI:1841216421
Name:TANWEER MEMON MD PA
Entity Type:Organization
Organization Name:TANWEER MEMON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TANWEER
Authorized Official - Middle Name:
Authorized Official - Last Name:MEMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:941-625-9494
Mailing Address - Street 1:2091 TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-2112
Mailing Address - Country:US
Mailing Address - Phone:941-625-9494
Mailing Address - Fax:941-743-8562
Practice Address - Street 1:2091 TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-2112
Practice Address - Country:US
Practice Address - Phone:941-625-9494
Practice Address - Fax:941-743-8562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0074367207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL42648OtherBCBS
FL258993100Medicaid
FLQ0131Medicare PIN
FL42648OtherBCBS
FL258993100Medicaid