Provider Demographics
NPI:1003894601
Name:TAMIM, WAEL Z (MD)
Entity type:Individual
Prefix:DR
First Name:WAEL
Middle Name:Z
Last Name:TAMIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:WAEL
Other - Middle Name:Z
Other - Last Name:TAMIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 350483
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33335-0483
Mailing Address - Country:US
Mailing Address - Phone:954-616-1916
Mailing Address - Fax:954-525-0808
Practice Address - Street 1:1625 SE 3RD AVE
Practice Address - Street 2:SUITE 723
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2521
Practice Address - Country:US
Practice Address - Phone:954-616-1916
Practice Address - Fax:954-525-0808
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83922208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264125900Medicaid
H56340Medicare UPIN
FL264125900Medicaid