Provider Demographics
NPI:1700167640
Name:TABASH, ISMAIL (MD)
Entity type:Individual
Prefix:DR
First Name:ISMAIL
Middle Name:
Last Name:TABASH
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 1:13127 VAIL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-7196
Mailing Address - Country:US
Mailing Address - Phone:813-661-3199
Mailing Address - Fax:
Practice Address - Street 1:13127 VAIL RIDGE DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-7196
Practice Address - Country:US
Practice Address - Phone:813-661-3199
Practice Address - Fax:813-661-6334
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI67458207RC0000X
IL036166773207RC0000X, 207RI0011X
FLME156591207RI0011X
AZR72859390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL114619700Medicaid