Provider Demographics
NPI:1881174779
Name:TNAEEMMD LC
Entity type:Organization
Organization Name:TNAEEMMD LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAHIR
Authorized Official - Middle Name:
Authorized Official - Last Name:NAEEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-357-0104
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34973-0490
Mailing Address - Country:US
Mailing Address - Phone:863-357-0104
Mailing Address - Fax:
Practice Address - Street 1:2257 US HIGHWAY 441 N STE A
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-1943
Practice Address - Country:US
Practice Address - Phone:863-357-0104
Practice Address - Fax:863-357-3025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-20
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty