Provider Demographics
NPI:1396974614
Name:VANA, TED ROBERT (DO)
Entity type:Individual
Prefix:
First Name:TED
Middle Name:ROBERT
Last Name:VANA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:14750 NW 77TH CT STE 100
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1507
Mailing Address - Country:US
Mailing Address - Phone:786-758-3165
Mailing Address - Fax:
Practice Address - Street 1:4450 E FLETCHER AVE STE D
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4907
Practice Address - Country:US
Practice Address - Phone:813-632-8861
Practice Address - Fax:813-977-4907
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2025-03-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS-009175-L2083P0500X
FLOS 105512083P0500X
FLOS10551207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine