Provider Demographics
NPI:1912366428
Name:THYROID ENDOCRINOLOGY AND DIABETES SPECIALISTS OF TAMPA LLC
Entity Type:Organization
Organization Name:THYROID ENDOCRINOLOGY AND DIABETES SPECIALISTS OF TAMPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMBREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:QURESHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-474-3636
Mailing Address - Street 1:4030 HENDERSON BLVD STE 701
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-4940
Mailing Address - Country:US
Mailing Address - Phone:813-474-3636
Mailing Address - Fax:813-862-2536
Practice Address - Street 1:2204 ASHLEY OAKS CIR
Practice Address - Street 2:SUITE 102
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6426
Practice Address - Country:US
Practice Address - Phone:813-474-3636
Practice Address - Fax:813-862-2536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-12
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME115520207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty