Basic Information
| Provider Information | |||||||||
| NPI: | 1194895243 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MIR | ||||||||
| FirstName: | TANVEER | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2501 N ORANGE AVE | ||||||||
| Address2: | SUITE 235 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328044603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073032906 | ||||||||
| FaxNumber: | 4073037126 | ||||||||
| Practice Location | |||||||||
| Address1: | 2501 N ORANGE AVE | ||||||||
| Address2: | SUITE 235 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328044603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073032906 | ||||||||
| FaxNumber: | 4073037126 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2006 | ||||||||
| LastUpdateDate: | 10/09/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | ME 125740 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 207RH0002X | ME 125740 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine | 207RG0300X | 179063 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 207RH0002X | 179063 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine |
No ID Information.