Provider Demographics
NPI:1982928560
Name:TENNENBAUM, MARC EDWARD (DO)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:EDWARD
Last Name:TENNENBAUM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 S OCEAN DR
Mailing Address - Street 2:APT 1905
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33019-2898
Mailing Address - Country:US
Mailing Address - Phone:305-747-3179
Mailing Address - Fax:
Practice Address - Street 1:3900 N POWERLINE RD
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33073-3013
Practice Address - Country:US
Practice Address - Phone:954-973-4485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8355207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine