Provider Demographics
NPI:1770566531
Name:KATTIH, MAZEN (MD)
Entity type:Individual
Prefix:
First Name:MAZEN
Middle Name:
Last Name:KATTIH
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:PO BOX 291489
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33687-1489
Mailing Address - Country:US
Mailing Address - Phone:813-571-0500
Mailing Address - Fax:813-571-0512
Practice Address - Street 1:116 PARSONS PARK DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-6066
Practice Address - Country:US
Practice Address - Phone:813-571-0500
Practice Address - Fax:813-571-0512
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-25
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME79267207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261133300Medicaid
FLG99311Medicare UPIN