Provider Demographics
NPI:1952316689
Name:IZHAR, TAHSEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:TAHSEEN
Middle Name:
Last Name:IZHAR
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 1:2055 S US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32962-7206
Mailing Address - Country:US
Mailing Address - Phone:772-794-0030
Mailing Address - Fax:772-794-0379
Practice Address - Street 1:214 NE 19TH DRIVE
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-1918
Practice Address - Country:US
Practice Address - Phone:863-357-9677
Practice Address - Fax:863-763-4509
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82236207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH37439Medicare UPIN
FLE552ZMedicare ID - Type Unspecified