Provider Demographics
NPI:1720065212
Name:BEYSOLOW, TAWEH D (MD)
Entity Type:Individual
Prefix:
First Name:TAWEH
Middle Name:D
Last Name:BEYSOLOW
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 1:1111 12TH ST STE 108
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-4087
Mailing Address - Country:US
Mailing Address - Phone:305-293-5015
Mailing Address - Fax:305-293-5016
Practice Address - Street 1:1111 12TH ST STE 108
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4087
Practice Address - Country:US
Practice Address - Phone:305-293-5015
Practice Address - Fax:305-293-5016
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172244207R00000X, 207RN0300X
NY17224207R00000X
FLME10891207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104237700Medicaid