Provider Demographics
NPI:1770591638
Name:KNEZ, TATIANA (MD)
Entity type:Individual
Prefix:
First Name:TATIANA
Middle Name:
Last Name:KNEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 INTRACOASTAL POINTE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-5036
Mailing Address - Country:US
Mailing Address - Phone:561-575-3050
Mailing Address - Fax:561-575-3153
Practice Address - Street 1:108 INTRACOASTAL POINTE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-5036
Practice Address - Country:US
Practice Address - Phone:561-575-3050
Practice Address - Fax:561-575-3153
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80480207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE4486AOtherMEDICARE PTAN
FLE4486Medicare ID - Type Unspecified
FLE4486AOtherMEDICARE PTAN